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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005436
Report Date: 03/28/2023
Date Signed: 03/28/2023 02:57:01 PM

Document Has Been Signed on 03/28/2023 02:57 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:VICTORIA VILLA HOMEFACILITY NUMBER:
306005436
ADMINISTRATOR:OLTEANU, CLAUDIAFACILITY TYPE:
740
ADDRESS:11132 FRALEY STREETTELEPHONE:
(949) 232-9619
CITY:GARDEN GROVESTATE: CAZIP CODE:
92841
CAPACITY: 6CENSUS: 6DATE:
03/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Edna Jose
Claudia Olteanu		TIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPA was greeted and granted entry by Staff Edna Jose. LPA discussed the purpose of the inspection and Administrator (AD) Claudia Olteanu was contacted by phone and arrived at 1:03 p.m.

During the inspection LPA, Staff Jose, and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, staff rooms, kitchen, garage and observed the following:

This is a single-story house with six resident bedrooms, four bathrooms, and three staff bedrooms. All resident bedrooms had the required furnishings. LPA observed all resident beds had linens and blankets. LPA observed all windows were screened. The back yard has a shaded sitting area. LPA observed two staff and six residents present. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested at between 108.6 and 109.4 F degrees.

LPA observed emergency disaster plan with means of exiting and emergency phone numbers listed and posted. Food menu was also posted and visible. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Two out of two fire extinguishers were observed to be mounted and fully charged. Sharps were observed to be locked in a kitchen drawer. All and any toxic chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to residents. Medication was observed to be locked. The first aid kit has all the required elements. LPA reviewed three resident files and three staff files. LPA interviewed two residents and one staff.

Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report was left at the facility.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE: DATE: 03/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/28/2023
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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