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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107206933
Report Date: 09/22/2022
Date Signed: 09/22/2022 01:31:20 PM

Document Has Been Signed on 09/22/2022 01:31 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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:VICTORIA'S CARE HOMEFACILITY NUMBER:
107206933
ADMINISTRATOR:GITTI, JOSEPHFACILITY TYPE:
740
ADDRESS:6736 N WESTERN AVETELEPHONE:
(408) 482-6166
CITY:FRESNOSTATE: CAZIP CODE:
93722
CAPACITY: 6CENSUS: 5DATE:
09/22/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
10:26 AM
MET WITH:Joseph GittiTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Katie Brown arrived at the facility unannounced to conduct a Health & Safety Inspection in conjunction with an initial complaint visit. LPA met with and explained the purpose of the inspection with Administrator (AD) Joseph Gitti.

During the visit LPA toured the facility. LPA observed residents in common areas waiting for lunch to be served or in their rooms watching television. During the tour, LPA observed resident’s bedrooms and bathrooms. Required furnishings were in place and in good condition. Bathroom water temperature was recorded at 118 degrees. Cleaning and disinfecting supplies as well as knives were locked. Towels, bedding, linens and paper products were properly stored. Medications and resident files were observed and locked. The facility has a pool with a gate which was locked. LPA observed required food supplies and kitchen appliances in working order. Common areas and walkways were free of obstruction. Facility temperature was 78 degrees. Fire Alarm and Carbon Monoxide detectors were observed. Fire Extinguisher service date was 1/20/22.


No deficiencies were cited during this inspection




An exit interview was conducted, and a copy of this report was left with AD, whose signature on this form confirm receipt of these documents.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Katie Brown
LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2022
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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