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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209080
Report Date: 09/24/2024
Date Signed: 09/25/2024 06:05:25 AM

Document Has Been Signed on 09/25/2024 06:05 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:
107209080
ADMINISTRATOR/
DIRECTOR:
GITTI, JOSEPHFACILITY TYPE:
740
ADDRESS:5288 N. ROSALIA AVETELEPHONE:
(559) 960-3789
CITY:FRESNOSTATE: CAZIP CODE:
93723
CAPACITY: 6CENSUS: 4DATE:
09/24/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:45 PM
MET WITH:Joseph Gitti, AdministratorTIME VISIT/
INSPECTION COMPLETED:
05:30 PM
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On 09/24/24, Licensing Program Analyst (LPA) arrived at the facility unannounced to conduct a case management visit based on an incident report received. LPA was greeted by caregiver, stated the purpose of the visit and was allowed entry into the facility. Administrator arrived to the facility shortly after LPA's arrival.

On 07/15/24, LPA received an incident report from the facility stating staff observed Resident R1 not feeling well. Facility contacted Emergency Medical Services (EMS) who transported R1 to hospital. R1 was admitted and discharged back to the facility on 07/20/24.

On 07/23/24, staff observed R1's oxygen level to be low and again and contacted EMS, who transported R1 to hospital and again admitted. R1 was reassessed and discharged back to the facility with Home healthcare services.

LPA observed R1 at the time of visit to be clean, well groomed and alert. LPA observed Home Healthcare plans, facility restricted health care plans and evidence of training. Exit interview conducted with Administrator. No deficiencies cited.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE: DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/24/2024
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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