<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209080
Report Date: 10/20/2021
Date Signed: 10/21/2021 09:05:56 AM

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:GITTI, JOSEPHFACILITY TYPE:
740
ADDRESS:5288 N. ROSALIA AVETELEPHONE:
(559) 960-3789
CITY:FRESNOSTATE: CAZIP CODE:
93723
CAPACITY:6CENSUS: 3DATE:
10/20/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Joseph Gitti - Licensee/AdministratorTIME COMPLETED:
11:15 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 10/20/2021, Licensing Program Analyst(LPA) D. Ayers arrived at facility unannounced to conduct a Required Annual Inspection. LPA met with Licensee/Administrator Joseph Gitti. Administrator certificate is current with renewal date 3/30/2023.

LPA toured facility inside and out. All passageways and exits were clear and free from obstruction. All smoke detectors and carbon monoxide detector were functional. Facility was adequately furnished and lit. Facility was at a comfortable temperature. LPA observed adequate supply of nonperishable and perishable food stuffs. LPA observed chemicals and hazardous materials to be stored in locked cabinets. Facility had first aid kit which contained all required items. Medication was secured in locked kitchen cabinet and appeared to be administered properly.

LPA toured resident bedrooms and bathrooms. All bedrooms were adequately furnished and lit. Bathrooms have secure grab bars and nonskid mats. LPA observed a sufficient supply of extra blankets and linens in hallway cabinets. LPA and Administrator discussed infection control guidelines and best practices. Administrator agreed to provide LPA with LIC 610E and LIC 500 by 11/3/2021. No deficiencies cited during the inspection. Exit interview conducted and a copy of this report provided via email.
SUPERVISOR'S NAME: Andy XiongTELEPHONE: (559) 650-7904
LICENSING EVALUATOR NAME: David AyersTELEPHONE: (559) 650-7925
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1