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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209080
Report Date: 11/02/2023
Date Signed: 11/05/2023 11:43:44 AM


Document Has Been Signed on 11/05/2023 11:43 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:GITTI, JOSEPHFACILITY TYPE:
740
ADDRESS:5288 N. ROSALIA AVETELEPHONE:
(559) 960-3789
CITY:FRESNOSTATE: CAZIP CODE:
93723
CAPACITY:6CENSUS: 4DATE:
11/02/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Harmeen Jhutti, Administrator TIME COMPLETED:
04:45 PM
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 11/02/23, Licensing Program Analyst (LPA) L. Salazar arrived to the facility unannounced to conduct the required Annual Inspection Visit. LPA was greeted by caregiver, stated the purpose of the visit and was allowed entry into the facility. Administrator on record is Hareem Jhutti, Certificate #6064227740 , Exp. 11/22/2024.

LPA toured the facility inside and out and observed the facility temperature read at 73 degrees F. Resident bedrooms were observed to have the required lighting/furnishings and are free from odor and passageway obstruction/fire hazards. Bathrooms were observed to have operational lights, running water, and non- slip floors. Hot water temperature tested at 110 degrees F.

Required postings were observed . Resident Council meeting minutes were observed to be dated October 2023. Cleaning supplies were observed to be locked in the laundry room closet located in the kitchen. LPA toured the kitchen observed the required 7-day supply of non-perishable food and 2- day supply of fresh perishables to be properly stored.

Carbon monoxide detectors were observed to be operational. Fire Extinguisher was observed to have a service date of 01/14/23. First aid kits were observed to contain all required items. Medications were observed to be locked in a cabinet in the kitchen. Quarterly Emergency Disaster Drill logs were observed for staff. A sample of Resident and Staff files will be reviewed at a later date on an annual continuation visit.

LPA is requesting the following documents be submitted to the Fresno CCL office by 11/13/2023: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Liability Insurance Emergency and Disaster Plan (LIC 610E) Personnel Report (LIC500), Register of Facility Clients/Residents (LIC9020A), Surety Bond. An exit interview was conducted with Administrator. A copy of this report was discussed and provided at the time of visit. No deficiencies cited on today's visit.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:
DATE: 11/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/02/2023
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