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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005436
Report Date: 03/06/2025
Date Signed: 03/06/2025 04:44:45 PM

Document Has Been Signed on 03/06/2025 04:44 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:VICTORIA VILLA HOMEFACILITY NUMBER:
306005436
ADMINISTRATOR/
DIRECTOR:		OLTEANU, CLAUDIAFACILITY TYPE:
740
ADDRESS:11132 FRALEY STREETTELEPHONE:
(949) 232-9619
CITY:GARDEN GROVESTATE: CAZIP CODE:
92841
CAPACITY: 6CENSUS: 6DATE:
03/06/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Claudia OlteanuTIME VISIT/
INSPECTION COMPLETED:
04:58 PM
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Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. At around 1:00 PM, LPA Tea was greeted and granted entry into the facility by caregiver, Edna Jose and explained the reason for the visit. Administrator (AD) Claudia Olteanu arrived shortly to assist with the visit. Facility is licensed for six non-ambulatory residents of which one maybe bedridden, with a hospice waiver for two. Currently there are six residents, of which one is on hospice during today's visit.

At 1:15 PM, LPA Tea reviewed six resident files and two staff files. Resident files and staff files contained all required documentation. Administrator certificate expires on June 13, 2026.



LPA Tea along with the staff toured the facility at 2:24 PM. LPA toured the physical plant, checked food service, and the first aid kit. The home consists of six resident bedrooms, three staff rooms, four full bathrooms, living room, dining room, office recreational room, kitchen and a detached garage. LPA observed smoke detectors/carbon monoxide in common areas and bedrooms are operational. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured around 106.1 F degrees. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, and doorways were free of obstructions. First aid kit had all the required elements including dressing, bandages, tweezers, thermometer, and scissors. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. LPA observed sharps locked in a kitchen drawer. LPA also observed toxin substances to be secured and locked and inaccessible to clients underneath the kitchen sink and the garage. Fire extinguishers throughout the facility are fully charged and last inspected on December 24, 2024. The facility’s last fire drill was conducted

Annual inspection continued on LIC809-C

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: VICTORIA VILLA HOME
FACILITY NUMBER: 306005436
VISIT DATE: 03/06/2025
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on January 15, 2025. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and there is ample seating with shade and there are two exit gates on both sides of the house that are self-latching and operational. The backyard has a patio area for clients to seat with umbrella for shade. There are fruit trees, plants and flowers in the garden, sometimes the residents sit out to enjoy a meal when the weather permits. LPA observed emergency supplies, food and water stored in containers in the staff office area. They have extra emergency water supply in the dining room. Facility provides activities like exercise; they love to do Zumba. They go on outings to have lunch, walk to the park, and walk around the neighborhood. At the time of the visit, LPA observed residents watching television and coloring in their room.

At 3:10 LPA checked P&I Funds, there were no discrepancies. LPA then reviewed medication storage and administration. Medications are stored in a locked closet in the staff office area. Medications are being administered per physician order. LPA interviewed clients regarding their quality of care and spoke to staff present regarding care provided.



Based on the observation made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations.

This report was reviewed with the facility and a copy of this report LIC809, 809-C, LIC858, LIC859, was read and provided to the facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025
LIC809 (FAS) - (06/04)
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