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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604741
Report Date: 10/15/2024
Date Signed: 10/15/2024 01:49:19 PM

Document Has Been Signed on 10/15/2024 01:49 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:WIND RIVER FAMILY CARE IIFACILITY NUMBER:
374604741
ADMINISTRATOR/
DIRECTOR:		JULIAN PETROVFACILITY TYPE:
735
ADDRESS:2567 WIND RIVER RD.TELEPHONE:
(619) 486-6324
CITY:EL CAJONSTATE: CAZIP CODE:
92019
CAPACITY: 4CENSUS: 3DATE:
10/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Julian Petrov, Licensee and Irina Todorova, Administrator TIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced required Annual Inspection. The facility file was reviewed prior to the visit. LPA Lopez identified herself, was granted entry by Licensee Julian Petrov and Administrator Irina Todorova. LPA discussed the purpose of the visit with Licensee Petrov and Administrator Todorova.

According to the facility’s license, there may be a maximum of four (4) clients all of whom shall be ambulatory in at any given time at the facility site. Room #1 is to be used by staff only. During today’s inspection, the facility’s current census is three (3) clients living at the facility. There were no clients present at the facility site during the inspection.

LPA, accompanied by Licensee Petrov and Administrator Todorova, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and activities.

The facility’s ambient internal temperature was comfortable and compliant, at 72 degrees Fahrenheit (F). Hot water temperature at taps accessible to clients were also compliant: kitchen sink measured hot water at 106.7 degrees F; sink in restroom #1 delivered hot water at 111.7 degrees F; sink in restroom #2 delivered hot water at 108.3 degrees F; and laundry room delivered hot water at 107 degrees F.

There was at least 2 days of perishable food, and at least 7 days non-perishable food present. Cooking, dining equipment and utensils were present, and all safely stored. There were no toxic chemicals or poisons accessible to clients. Medications were properly labeled, as required, and stored in locked area which LPA inspected. The facility-maintained medication logs which LPA reviewed.

[CONTINUED ON LIC 809-C]
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/15/2024
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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: WIND RIVER FAMILY CARE II
FACILITY NUMBER: 374604741
VISIT DATE: 10/15/2024
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[CONTINUED FROM LIC 809]

The facility had a pool on the facility premises. The pool had a fence that is in good repair and is designed to surround the pool and may not be removed. The fence is 5 feet high and constructed that the view is not obstructed from view and may not be climbed into. The gate swings away from the pool and is self-closed and self-latches which is not more than 6” from the top of the gate. Openings between railings do not exceed 4” and the bottom of the fence is no more than 4” from the ground. The fence is thick enough that it can not be easily broken or removed. Licensee and Administrator agreed to have the fencing remain in place and properly functioning whenever there are licensed clients in care. Licensee and Administrator also agreed to have any ladder inaccessible whenever there are licensed clients in care.

Per licensee Prtrov and Administrator Todorova, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguishers were present (02) and serviced within the last 12 months. First aid kits were complete and readily accessible.

LPA was unable to interview staff or clients, but reviewed staff and client records. During today’s visit there were no clients or staff on the facility premise. LPAs visit did not raise any licensing concerns. The files which LPA reviewed contained required documents. Confidential records were stored in a locked area. Required licensing postings were observed in a visible area of the facility.

There were no deficiencies observed or cited during today's annual inspection.

An exit interview was conducted with Licensee Petrov and Administrator Todorova to whom a copy of this report along with the Licensee/Appeal Rights (LIC9058 03/22) were provided at the conclusion of the visit. The signature below confirms the documents were received.

The facility did have current Designation of Administrative Responsibility LIC 308, Personnel Report LIC 500, Emergency Disaster Plan LIC 610-D, Residential Infection Control Plan LIC 9282 (6/23), and Liability insurance on file.
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024
LIC809 (FAS) - (06/04)
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