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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208904
Report Date: 10/24/2024
Date Signed: 10/24/2024 11:43:22 AM

Document Has Been Signed on 10/24/2024 11:43 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, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:VICTORIA'S CARE HOMEFACILITY NUMBER:
107208904
ADMINISTRATOR/
DIRECTOR:
GITTI, JOSEPHFACILITY TYPE:
740
ADDRESS:5934 W LOCUST AVETELEPHONE:
(559) 960-3789
CITY:FRESNOSTATE: CAZIP CODE:
93722
CAPACITY: 6CENSUS: 4DATE:
10/24/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Joseph GitiTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Katie Brown arrived unannounced to conduct the Annual Inspection. LPA met with and explained the reason for the visit with Administrator/Licensee Joseph Gitti (AD).

During this visit, LPA toured the facility inside & out. Resident rooms and common areas were clean, in good repair and contained required equipment, furnishings and lighting. LPA observed required items in bathrooms with hot water measuring 109 degrees. LPA observed hygiene items, towels, extra bedding, and linens which were stored and available for use. The kitchen was observed to be clean, in good repair with necessary items and appliances. LPA observed required food supply and paper products. Knives, cleaning/disinfecting supplies and chemicals were locked are stored separate from food. Medications are centrally stored in a locked kitchen cabinet. Doors and passageways are unobstructed throughout the facility including outdoors. A First aid kit contained required items. LPA walked the outdoors to find the grounds well-kept with clear walkways, sitting area and a gate with working latch. Fire extinguishers were serviced by Midstate Fire Co. on 1/4/24. Smoke and carbon monoxide detectors were observed and tested. LPA conducted resident and staff file reviews, P&I and a medication audit. Emergency Disaster and Infection Control requirements were reviewed during the inspection.

There were no citations during this inspection.

An exit interview was conducted and a copy of this report was signed and provided.

LPA requested the following updated forms faxed to CCLD by 11/1/24: Designation of Facility Responsibility (Lic308), Administrative Organization (Lic309), Affidavit Regarding Client/Resident Cash Resources (LIC 400), Surety Bond (Lic402), Emergency Disaster Plan LIC610D (12/22), Personnel Report (LIC 500), Client Roster (LIC 9020), Proof of current Liability Coverage.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Katie Brown
LICENSING EVALUATOR SIGNATURE: DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2024
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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