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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604612
Report Date: 12/15/2022
Date Signed: 12/15/2022 10:29:23 AM

Document Has Been Signed on 12/15/2022 10:29 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, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:VICTORIOUS LIVING RESIDENCEFACILITY NUMBER:
374604612
ADMINISTRATOR:GONZALEZ, EDUARDO JR.FACILITY TYPE:
735
ADDRESS:9231 GOLONDRINA DRTELEPHONE:
(619) 439-2456
CITY:LA MESASTATE: CAZIP CODE:
91941
CAPACITY: 4CENSUS: 0DATE:
12/15/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Administration Eduardo Gonzalez Jr. TIME COMPLETED:
10:35 AM
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Licensing Program Analyst (LPA) Kayla Hilario, conducted an announced Pre-Licensing inspection. LPA met with Administration Eduardo Gonzalez Jr., and we discussed the purpose of the visit.

LPA conducted a tour of the facility, both inside and outside. There are no pools on site. The smoke and carbon monoxide alarms were present. Toilets intended for client use were operating as intended, and bathing facilities were observed to be clean and kempt. The windows, blinds and paint throughout the facility, was observed in good condition. Each room intended for client use had the appropriate furniture, bedding and appropriate lighting. Administrator Gonzalez reported that there are no firearms on the premises.

Hot water temperature was measured in the facility at 112 degrees F in the upstairs bathroom and 115 degrees F in the kitchen. The ambient temperature inside the facility was measured with at 70 degrees F. The facility was observed to be clean and kempt with no strong malodors. The refrigerators and freezers were observed to be clean and operational, with an ample amount of food to meet client needs. Cleaning solutions were also properly secured in the garage.

The Component III portion of the application process was completed with Gonzalez and his staff on today's date as well.

The facility does not have an evacuation chair as required by Health and Safety Code Section 1565(f)(1). Pre-Licensing is incomplete with deficiencies to be resolved by January 15, 2022. An exit interview was conducted. The Applicant was provided a hardcopy of this report and their Appeal/Licensee rights (LIC9058 03/22) at the conclusion of the visit.
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Kayla Hilario
LICENSING EVALUATOR SIGNATURE: DATE: 12/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/15/2022
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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