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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107206734
Report Date: 12/05/2022
Date Signed: 12/05/2022 03:29:55 PM

Document Has Been Signed on 12/05/2022 03:29 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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:VICTORIA'S CARE HOMEFACILITY NUMBER:
107206734
ADMINISTRATOR:JOSEPH GITTIFACILITY TYPE:
740
ADDRESS:6722 N. DELBERT AVE.TELEPHONE:
(559) 495-9859
CITY:FRESNOSTATE: CAZIP CODE:
93722
CAPACITY: 6CENSUS: 4DATE:
12/05/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Joseph GittiTIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Katie Brown arrived at the facility unannounced to conduct the Annual Inspection - Infection Control. LPA met with and explained the purpose of the visit with Administrator (AD) Joseph Gitti.

LPA toured the facility inside and out. Upon entry, LPA observed visitor log/symptom screening and sanitizer. Covid-19 symptom and precautionary signs are posted at entry and throughout the facility. Furniture in common and dining areas are spaced to promote distancing. Facility has designated visitation areas available. LPA observed soap, paper towels and hand washing signs in bathrooms. LPA observed required food supply, paper products, available PPE and resident medications. Cleaning/disinfecting products and sharps/knives were locked. LPA reviewed resident emergency contact information. Fire and Carbon Monoxide alarms were observed in working order. LPA observed fire extinguishers dated 1/20/22.

No deficiencies were cited during this inspection.


An exit interview was conducted. A copy of this report was left with Joseph Gitti whose signature confirms receipt of these documents.




LPA requested the following updated forms by 12/12/22: LIC 308, LIC 400, LIC 402, LIC 500, LIC 610,
LIC 9020, a copy of current Liability Coverage.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Katie Brown
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2022
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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