374604741-11-21-2023-08-AS-DNGN-CXSPVX-20231121103951

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604741
Report Date: 11/21/2023
Date Signed: 11/21/2023 10:40:11 AM

Document Has Been Signed on 11/21/2023 10:40 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME:	WIND RIVER FAMILY CARE II		FACILITY NUMBER:	374604741
ADMINISTRATOR:	JULIAN PETROV		FACILITY TYPE:	735
ADDRESS:	2567 WIND RIVER RD.		TELEPHONE:	(619) 486-6324
CITY:	EL CAJON	STATE: CA	ZIP CODE:	92019
CAPACITY: 4		CENSUS: 0	DATE:	11/21/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Applicant Julian Petrov and Manager Irina Todorova		TIME COMPLETED:	11:00 AM

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Licensing Program Analyst (LPA) Dang Nguyen conducted an announced Pre-Licensing visit to observe the facility’s physical plant for compliance with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code. LPA was greeted by, identified himself to, and explained the purpose of the visit to Applicant Julian Petrov and Manager Irina Todorova

The facility fire clearance was granted on 10/25/2023 and reflected that the facility was approved for four (4) clients in total, of which all must be ambulatory. The facility's fire clearance did not include endorsements for delayed-egress doors or secured perimeter, and neither were present during today's visit. The submitted facility sketch was consistent with the current layout of the facility.

During today’s visit, LPA, accompanied by the applicant, toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were well lit and free of obstruction and slip hazards. Client bedrooms allowed for easy passage and the applicant possessed the required furnishings. Toilets, sinks, and showers were in working order. The facility’s ambient internal temperature was complaint at 70 degrees F. Hot water temperature at taps accessible to clients were also compliant: Kitchen sink was 109.6 F, Bathroom #1 sink was 106.5 F, and Bathroom #2 sink was 105.1 F.

The facility has enough linens, hygiene supplies, cooking and dining supplies, and perishable and non-perishable food for future client use. All kitchen appliances were in working order. Refrigerator temperature was 39 F, and freezer temperature was 0 F.

[CONTINUED ON LIC 809-C]

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2023

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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: WIND RIVER FAMILY CARE II	FACILITY NUMBER: 374604741
	VISIT DATE: 11/21/2023

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[CONTINUED FROM LIC 809]

The facility has sufficient space and equipment to facilitate laundry, visitation, meetings, and client activities. The facility has locked areas for storage of sharp objects, medications, and confidential client and staff records.

The facility's swimming pool was behind a fence and locking gate meeting regulatory requirements. There were no toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to clients. Per the applicant’s representative, no firearms or ammunition are or will be stored at the facility.

Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all operational. Fire extinguishers were serviced within the last 12 months. The applicant possessed a complete first aid kit and required licensing postings.

The items reviewed were complaint with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code. The applicant passed the pre-licensing inspection.

LPA also provided the Component III Training during today’s visit. Petrov and Todorova were advised that the facility’s application is pending management final review and approval.

An exit interview was conducted with the applicant and his manager, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2023

LIC809 (FAS) - (06/04)

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