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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202473
Report Date: 04/07/2026
Date Signed: 04/07/2026 12:14:28 PM

Document Has Been Signed on 04/07/2026 12:14 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: 15DATE:
04/07/2026
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:39 AM
MET WITH:Cyril InnehTIME VISIT/
INSPECTION COMPLETED:
12:25 PM
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Licensing Program Analyst (LPA) Marcela Yanez and Licensing Program Manager (LPM) Christine Kabariti conducted an unannounced Plan of Correction (POC) visit to clear a deficiency that was issued on 03/26/26.

During visit LPA and LPM received the POC from Administrator dated 03/27/26 that was not submitted by the POC due date 03/27/26. Based on interview with the administrator the POC was not submitted and ADM stated he submitted POC via email, upon checking he stated email was not sent.

The POC states the facility has implemented multiple layers of of treatment and mitigation to eliminate pests and prevent occurrences. The facility has had a contract with third party agency dated 11/21/24 that states third party agency will be conducting treatments bi-monthly. ADM stated he conducts treatments of approved treatment powder along baseboards and the installation of bed bug traps on all bed legs. ADM stated the facility has a written contract with a separate third party agency that will be tenting the facility to treat bed bugs, and cockroaches. ADM states the tenting and fumigation will be completed upon approval of the relocation due to renovations. The facility is still planning to relocate residents for renovation and treatment of pests. During visit, ADM provided a new maintenance service agreement dated 04/07/2026, which changed from a bi-monthly to monthly service schedule for the treatment of crawlers.

Around 9:20AM, LPA and LPM toured the facility bedrooms #1-12 and observed powder treatment on the baseboards of the rooms. No live bed bugs were observed during visit. LPA and LPM observed rooms (#10 and #4) were missing bed bug traps underneath the beds. LPA and LPM observed a strong smell of urine in bedrooms. LPA and LPM reminded ADM that the fan vent of the bathrooms need to be clean which were observed to have a thick layer of dust and grime. ADM stated that the staff are currently working on cleaning the facility. See LIC809-C.
NAME OF LICENSING PROGRAM MANAGER: Christine Kabariti
NAME OF LICENSING PROGRAM ANALYST: Marcela Yanez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/07/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: 04/07/2026
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At 10:54AM, LPA observed the vents were cleaned, staff were currently installing new bedbugs traps in room #10, and #4, and bathroom was mopped and sinks were cleaned. Regarding the odor, ADM states that laundry services are completed weekly for residents and bi-weekly for residents who are incontinent. ADM agreed to increase the incontinent resident's laundry services to more frequently and as needed, to help eliminate the odor and to ensure residents are provided clean linens. ADM states a plan to assist the incontinent residents.

At 9:38AM, LPA and LPM toured the home located at 373 East San Fernando St, San Jose CA 95112 which will be used as a relocation site during the renovation of this facility. The home currently has 5 tenants 2 of which are staff. LPA and LPM toured the home and observed 8 rooms that will be occupied by residents during the relocation. ADM states he is working on obtaining a fire clearance for the home. ADM states the process began the week of 03/30/2026 and the estimated completion dates is the end of week of 04/17/2026.
LPA and LPM reminded ADM that the current tenants at the relocation site need to be fingerprint cleared prior to residents residing in the home. ADM agreed and understood.

LPA and LPM informed the ADM regarding the importance is adhering to his non-compliance plan and staying in compliance with Title 22 regulations. ADM was also reminded of the importance of submitting the POCs on time. ADM states understanding.

During visit LPA and LPM observed the living room activity room in back yard being used as a bedroom for staff. The facility fire clearance and sketch does not list room to be used as living quarters. LPA took pictures with state provided phone that showed a mattress with sheets and personal belongings. LPA and LPM reminded ADM he needs to adhere to the approved fire clearance.

A deficiency was cited today per California Code of Regulations, Title 22. See LIC809-D.

This report was reviewed with Administrator, Cyril Inneh and a copy of the report and appeal rights were provided.
NAME OF LICENSING PROGRAM MANAGER: Christine Kabariti
NAME OF LICENSING PROGRAM ANALYST: Marcela Yanez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/07/2026 12:14 PM - It Cannot Be Edited


Created By: Marcela Yanez On 04/07/2026 at 11:38 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: VILA VICTORIA #1
FACILITY NUMBER: 435202473

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/07/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/08/2026
Section Cited
CCR
85087(a)(3)(A)

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85087 Buildings and Grounds
(a) (3) No room commonly used for other purposes shall be used as a bedroom for any person. (A) Such rooms shall include but not be limited to ... garages, storage areas, and sheds, or similar detached buildings.This requirement was not met as evidenced by:
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ADM stated the staff will moving out immediately and mattress will be removed. ADM will provide photo of room after removal of mattress. ADM will submit a letter of understanding of the regulation by POC due date 04/08/26.
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Based on observation,interview and record review, ADM stated that staff is occupying the living/activity room as a bedroom.The living room has been converted to a bedroom with no updated fire clearance which poses an immediate Health, Safety, or Personal Rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Christine Kabariti
NAME OF LICENSING PROGRAM MANAGER:
Marcela Yanez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/07/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/07/2026


LIC809 (FAS) - (06/04)
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