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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 365530281
Report Date: 11/26/2024
Date Signed: 11/26/2024 11:21:12 AM

Document Has Been Signed on 11/26/2024 11:21 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
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:VICTORIA UNITY LLCFACILITY NUMBER:
365530281
ADMINISTRATOR/
DIRECTOR:		ADERONMU, OLUWATOYOSIFACILITY TYPE:
735
ADDRESS:16803 DESERT STAR STTELEPHONE:
(951) 251-9123
CITY:VICTORVILLESTATE: CAZIP CODE:
92394
CAPACITY: 4CENSUS: 0DATE:
11/26/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:25 AM
MET WITH:Administrator, Oluwatoyo AderonmuTIME VISIT/
INSPECTION COMPLETED:
11:20 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
Licensing Program Analyst (LPA) Renese Howell-Small conducted an announced visit to the facility for purpose of a Pre-Licensing evaluation. I met with Administrator, Oluwatoyosi Aderonmu . An initial application to operate an Adult Residential Facility (ARF) was submitted to the Central Applications Bureau (CAB) on 07/29/2024 for a total capacity of four (4) four ambulatory residents. Fire clearance was granted on 09/19/2024. LPA Small observed the following:

Structure:
Facility is a house with four (4) resident bedrooms, two (2) resident bathrooms, living room, dining area and kitchen. There was an attached two car garage in the front of the house.

Heating /Cooling System:
Central heating and air conditioning system installed with a central panel located in the hallway which controls the entire house. LPA observed the of be 65 degrees Fahrenheit.

Bedrooms/Bathrooms:
All bedrooms are adequately furnished with a bed, dresser, chair, closet, appropriate linens, adequate lighting, Night lights were observed in the main hallway. Both bathrooms have working toilets, wash basin, and shower with an adequate supply of paper towels, toilet paper, and soap. The water temperature was measured at 116 degrees Fahrenheit.

Kitchen:
The kitchen has an adequate supply of dishes, glasses, utensils, pots and pans were observed. Knives/sharp instruments were secured in a locked drawer located in the kitchen. There was adequate room for food storage. LPA observed the stove to be operational. Refrigerator/freezer were in working condition. There was sufficient storage for perishable food. There was adequate seating for meals for all clients.



SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Renese Howell-Small
LICENSING EVALUATOR SIGNATURE: DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/26/2024
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: VICTORIA UNITY LLC
FACILITY NUMBER: 365530281
VISIT DATE: 11/26/2024
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
26
27
28
29
30
31
32
Laundry:
Laundry room with washer and dryer was located near the garage. Laundry detergents and cleaning supplies will be stored in the secured garage.

Living /Family Room:
There was a living/family room with a TV and adequate seating for all clients. LPA Small observed, books, boardgames and cards for resident activities.

Linens and Hygiene:
An adequate supply of linens was stored in a cabinet in the main hallway.

Yards/Outdoors:
There is sufficient covered seating area in the backyard. There is a gate on the left side of the property with a self-latching closure on the interior. All outdoor pathways were free of obstructions.
facility sketches were observed posted in the main hallway.

Two (2) fire extinguishers and seven (7) combination carbon monoxide/smoke detectors were observed to be operational and in good condition. LPA observed Personal Rights, Complaints posters, Visitor's policy, activity calendar and menu posted in the hallway.

General items:
Client and staff records will be stored in a locked cabinet in the garage First Aid kit with required components are located in locked kitchen cabinet. Medication will be locked in a cabinet in the kitchen. LPA did not observe a facility phone. Administrator stated a phone/phone service will be purchased. Emergency food and water was observed in a cabinet in the garage.

An exit interview was conducted, no deficiencies were cited, Component III was completed during this visit and a copy of this report was reviewed and provided to Administrator, Oluwatoyosi Aderonmu. .

According to Title 22 California Code of Regulations, Licensee/Administrator Oluwatoyosi Aderonmu has satisfied all of these requirements and is ready for licensure.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Renese Howell-Small
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2