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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209188
Report Date: 02/10/2025
Date Signed: 02/11/2025 09:22:29 AM

Document Has Been Signed on 02/11/2025 09:22 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 CARE HOME 2 INCFACILITY NUMBER:
107209188
ADMINISTRATOR/
DIRECTOR:		DAVOODI, NAHRINFACILITY TYPE:
740
ADDRESS:4770 W. OSWEGO AVETELEPHONE:
(559) 960-3789
CITY:FRESNOSTATE: CAZIP CODE:
93722
CAPACITY: 6CENSUS: 4DATE:
02/10/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Joseph GittiTIME VISIT/
INSPECTION COMPLETED:
01:00 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 (AD) Joseph Gitti.

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 (including shower mats & grab bars) which were clean with hot water measuring 109 degrees. LPA observed hygiene items, paper products, towels, extra bedding, and linens which were stored and available for use. The kitchen was found to be clean, in good repair with necessary items and appliances. LPA observed required food supply, emergency food, water, and paper products. Knives, cleaning/disinfecting supplies and chemicals are locked and stored separate from food. Medications are centrally stored in a locked kitchen cabinet. Doors and passageways are unobstructed throughout the facility including outdoors. First aid kit contained required items.

LPA walked the outdoors to find the grounds well-kept with clear walkways with sitting areas. LPA observed inside a shed in the back yard which is used for storage. Fire extinguishers were found to be charged and serviced on 1/8/25 by Midstate. Smoke and carbon monoxide detectors were observed and tested. LPA conducted resident and staff file reviews and conducted an audit of medication and P&I. Emergency Disaster and Infection Control procedures and 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 2/17/2025: Designation of Facility Responsibility (Lic308), Administrative Organization (Lic309), Affidavit Regarding Client/Resident Cash Resources (LIC 400), Surety Bond (Lic402) Personnel Report (LIC 500), Client Roster (LIC 9020) and Proof of current Liability Coverage.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Katie Brown
LICENSING EVALUATOR SIGNATURE: DATE: 02/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/10/2025
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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