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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202473
Report Date: 02/19/2025
Date Signed: 02/19/2025 05:04:23 PM

Document Has Been Signed on 02/19/2025 05:04 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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:VILA VICTORIA #1FACILITY NUMBER:
435202473
ADMINISTRATOR/
DIRECTOR:		MR. CYRIL INNEHFACILITY TYPE:
735
ADDRESS:393 E. SAN FERNANDO STREETTELEPHONE:
(408) 271-9244
CITY:SAN JOSESTATE: CAZIP CODE:
95112
CAPACITY: 23CENSUS: 18DATE:
02/19/2025
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Cyril InnehTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Non-Compliance visit and met with Cyril Inneh, Administrator (ADM).

During visit, LPA reviewed facility files, toured the facility, and interviewed staff and ADM. LPA Marrufo reviewed the facility Non-Compliance Plan with ADM, including the plan for ADM to notify Community Care Licensing (CCL) at least 7 days prior to any alterations or construction at the facility, ensuring that the facility is kept clean, safe, sanitary, and in good repair, including being free of bed bugs, flies, and insects, maintaining a weekly water temperature log, how the licensee will ensure resident's are accorded with personal rights in accommodations and their personal relationship with staff, how the licensee will ensure staff are not engaging in conduct that is inimical to the health, morals, welfare, or safety of the residents, how the licensee will ensure toxins are kept inaccessible to residents in care, how the licensee will ensure compliance with criminal record clearance per Title 22 regulations and describe the facility protocol when hiring staff, the licensee's plan to ensure the plan of operations contains information on staff's qualifications and duties and personnel policy regarding alcohol use during working hours, how the licensee will provide staff and the Administrator training by a professional in topics to include ensuring the facility is kept clean, safe, sanitary, and in good repair, maintaining the hot water temperature per Title 22, personal rights in accommodations and their personal relationship with staff, ensuring toxins are inaccessible to residents in care, and alcohol use during working hours for staff, how the licensee will ensure all applicable and accrued/licensing fees and civil penalties are paid, the licensee's plan to supervise the facility operations and monitor the facility administrator to operate according to regulations, and how the facility staff hiring policy will meet licensing requirements and needs of the residents.


See LIC809-C for more information. Page 1 of 2.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE: DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/19/2025
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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME: VILA VICTORIA #1
FACILITY NUMBER: 435202473
VISIT DATE: 02/19/2025
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During visit, LPA Marrufo observed toxins securely stored in cabinets and supply storage areas. LPA measured the bathroom water temperature and it measured at 105 F. LPA obtained a copy of ADM's registration with the department Guardian website, which allows for association of staff to the facility. LPA reviewed five staff records during visit and found them to have the necessary background check and association documentation. LPA advised ADM that an upcoming licensee fee is due on March 20th, 2025. LPA observed the pest control products at the facility and toured the resident bedrooms. LPA observed bed bugs in 3 out of 10 observed resident bedrooms. Two bedrooms were unoccupied during visit. LPA obtained copies of invoices from pest control companies, including a heat treatment that occurred on 06/14/2024 and two contracted spraying visits that occurred on 11/26/2024 and 01/23/2025.

LPA interviewed ADM, who stated that the next scheduled pest control visit will occur during March 2025.

ADM stated that ADM mitigates bed bugs and pests at the facility by scheduling heat treatments, contracted pest control sprays every other month, and by placing bed bug traps under the feet of each bed. Additionally, staff spray for bed bugs once a month, and staff vacuum resident bedrooms as well as demetrius earth around the base boards of the resident rooms. Staff launder resident clothing and bedding to mitigate the spread of bed bugs and pests at the facility.

LPA advised ADM to have all staff training records signed and dated. LPA advised ADM to keep a binder of all the non-compliance training records, pest control invoices, and other related documents.

Advisory Notes were issued. See LIC9102 for more information.

No deficiencies were cited as per California Code of Regulations Title 22. This report was reviewed with Administrator Cyril Inneh and a copy of this report was provided.



Page 2 of 2. END REPORT
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025
LIC809 (FAS) - (06/04)
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