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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600625
Report Date: 04/10/2024
Date Signed: 04/10/2024 04:18:08 PM

Document Has Been Signed on 04/10/2024 04:18 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
Lookup Error,
, CA
FACILITY NAME:VICTORIOUS RESIDENTIAL HOMEFACILITY NUMBER:
198600625
ADMINISTRATOR/
DIRECTOR:		ORUNESAJO, AKINWALE VICTORFACILITY TYPE:
735
ADDRESS:411 GARDA AVENUETELEPHONE:
(818) 448-3012
CITY:LA PUENTESTATE: CAZIP CODE:
91744
CAPACITY: 4CENSUS: DATE:
04/10/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:26 AM
MET WITH:Oluwagbemiro Odofin, Designee AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:27 PM
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Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced Case Management visit to the facility. The purpose of this visit is to serve the Order of Immediate Exclusion from facility for Staff #1 (S1). LPA met with Oluwagbemiro Odofin, Designee Administrator and explained the reason for the visit.

The Designated Administrator received an immediate exclusion letter for S1. The Administrator Akinwale Victor Orunesajo was not available because he left the country on 4/6/2024 and will return next Tuesday.

No immediate health and safety hazards were noted during this visit.

Exit interview conducted and a copy of the report was issued to the Designated Administrator.
SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE: DATE: 04/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/10/2024
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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