374602571-12-4-2024-18-AS-FSAS-DBMVL6-20241204153126

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374602571
Report Date: 12/04/2024
Date Signed: 12/04/2024 03:31:50 PM

Document Has Been Signed on 12/04/2024 03:31 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	OAK RANCH HOUSE		FACILITY NUMBER:	374602571
ADMINISTRATOR/ DIRECTOR:	STANOYLOVIC, MARIJA		FACILITY TYPE:	740
ADDRESS:	10449 OAK RANCH PLACE		TELEPHONE:	(760) 297-1091
CITY:	ESCONDIDO	STATE: CA	ZIP CODE:	92026
CAPACITY: 6	TOTAL ENROLLED CHILDREN: 0	CENSUS: 3	DATE:	12/04/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:24 PM
MET WITH:	Marja Stanoylovic - Administrator		TIME VISIT/ INSPECTION COMPLETED:	03:45 PM

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Licensing Program Analyst (LPA) Ferrer Sabarias conducted an unannounced annual required visit. Upon entry, LPA was greeted by Administrator Marija Stanoylovic and informed her of the purpose of the visit. At the time of the visit, there were 2 (two) staff members and 3 (three) residents present.

Facility Overview: The facility is a one-story home with 5 bedrooms for residents and 1 bedroom for staff and 3 (three) bathrooms, including an attached garage. There are no pools in the premises.

Infection Control: LPA observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility’s infection control plan was reviewed and found to meet department requirements.

Physical Plant: The physical plant, including floors, windows, and doors, was clean and well-maintained. Fixtures and furniture were in good repair. The outdoor area was free of hazards. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked and inaccessible to residents. According to the Administrator there are no firearms kept in the facility. Both the smoke detector and carbon monoxide detector were operational, and the hot water temperature was 109.4°F. Fire extinguishers are observed to be in good condition, last service date 4/4/2024.

Food Service: The facility’s kitchen was clean and equipped to prepare food. The facility maintained the required two-day supply of perishable foods and a seven-day supply of non-perishable foods.

Rikesha Stamps	TELEPHONE: (951) 212-0616
Ferrer Sabarias	TELEPHONE: (951) 248-2222
	DATE: 12/04/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: OAK RANCH HOUSE	FACILITY NUMBER: 374602571
	VISIT DATE: 12/04/2024

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Care & Supervision/Administration: Adequate staff were present to supervise clients during the visit. The administrator holds a current administrator’s certificate valid until 2/7/25.

Record Review and Resident/Staff Files: LPA reviewed files for two staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. Three resident files were reviewed and contained all required documentation.

Health-Related Services/Incidental Medical Services: All resident medications were securely locked. LPA reviewed medications for three residents, confirming that all medications were listed on the Medication Administration Record (MAR) and accounted for.

Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan, including documentation of the last fire drill conducted on 11/15/2024, which met department requirements. All facility exits were clear of obstructions.

No deficiencies were cited during the visit. An exit interview was conducted, during which this report was reviewed and provided to Marija Stanoylovic Administrator.

SUPERVISOR'S NAME: Rikesha Stamps	TELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Ferrer Sabarias	TELEPHONE: (951) 248-2222
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

LIC809 (FAS) - (06/04)

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