Victoria Care Home 2 Inc.

Type of visit: Required - 1 Year

On 12/31//2025, Licensing Program Analyst (LPA) M, Medina conducted an unannounced Annual Required Inspection visit. LPA arrived, introduced self, stated purpose of visit, and allowed entrance. Administrator contacted by telephone and arrived a short time later to conduct inspection visit with LPA. The facility is a 5 bedroom and 2 bathroom home, there are currently six (6) residents in home. All residents were home at time of visit. Facility tour began in residents bedrooms. All bedrooms observed to have required furnishings and adequate lighting. Resident bathroom toured, bathroom fixtures observed operational, grab bars, shower chair and skid-resistant mats available. Water temperature measured at 112 degrees F. Living room and dining room observed to have adequate seating available for residents in care. Kitchen toured, facility observed to have a 2-day supply of perishable and a 7-day supply of non-perishable food available. All knives observed to be locked and secured. Fire extinguisher present with a service date of 1/10/2025, smoke detectors and carbon monoxide detectors present and observed operational during inspections. All chemicals observed to be locked and secured in laundry room and under kitchen sink. Staff and resident files reviewed during inspection. Outside of facility toured. Facility has a shaded area with seating available. Exits observed free of obstruction. . No deficiencies observed. Exit interview conducted and a copy of report provided to licensee via e-mail.the state’s words, verbatim · CDSS document, Dec 31, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Katie Brown arrived unannounced to conduct the Annual Inspection. LPA met with and explained the reason for the visit with Administrator (AD) Joseph Gitti. During this visit, LPA toured the facility inside & out. Resident rooms and common areas were clean, in good repair and contained required equipment, furnishings and lighting. LPA observed required items in bathrooms with hot water measuring 116 degrees. LPA observed hygiene items, towels, extra bedding, and linens which were stored and available for use. The kitchen was observed to be clean, in good repair with necessary items and appliances. LPA observed required food supply and paper products. Knives, cleaning/disinfecting supplies and chemicals were locked are stored separate from food. Medications are centrally stored in a locked cabinet in the kitchen. Doors and passageways are unobstructed throughout the facility including outdoors. First aid kits contained required items. LPA walked the outdoors to find the grounds well-kept with clear walkways, sitting area and a gate with working latch. Fire extinguishers were found to be charged and were serviced by Midstate Fire Co. on 1/9/24. Smoke and carbon monoxide detectors were observed and tested. LPA conducted resident and staff file reviews, and medication audit. Emergency Disaster and Infection Control requirements were reviewed during the inspection. There were no citations during this inspection. An exit interview was conducted and a copy of this report was signed and provided. LPA requested the following updated forms faxed to CCLD by 11/15/23: Designation of Facility Responsibility (Lic308), Administrative Organization (Lic309), Affidavit Regarding Client/Resident Cash Resources (LIC 400), Surety Bond (Lic402), Emergency Disaster Plan LIC610E (12/22), Personnel Report (LIC 500), Client Roster (LIC 9020), Proof of current Liability Coverage.the state’s words, verbatim · CDSS document, Nov 8, 2024

Allegation investigated: Facility has a 'flip lock' on the inside of the main door of the home

Licensing Program Analyst (LPA) Katie Brown arrived unannounced to conduct the initial complaint investigation. LPA met with and explained the purpose of the visit and the element of the allegation with Licensee Joseph Gitti. The Department investigated the allegation above. Based on observation and interview, it was determined that the "flip lock" had been placed on the front door to prevent wandering residents from leaving. The preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. A deficiency is being cited in accordance with California Code of Regulations on the attached LIC 9099-D. An exit interview was conducted and the deficiency was cleared during this vsist. A copy of this report and Appeal Rights were discussed and left with AD, whose signature confirms receipt of these documents. Substantiatedthe state’s words, verbatim · CDSS document, Aug 22, 2024 · control 24-AS-20240820113800

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(6) · Plan of correction due date: Aug 29, 2024

87468.1 Personal Rights of Residents... (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (6) To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night…. This requirement was not met as evidenced by Licensee did not ensure residents personal rights. A "flip lock" was placed on the front door to prevent residents from wandering out of the facility. This poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Aug 22, 2024

Plan of correction: DEFICIENCY CLEARED Licensee immediately removed the "flip lock" from the door".

Type of visit: Office

Facility Type: RCFE Application Type: INITIAL Capacity: 6 Census (if any clients in care): COMP II Participants: NAHRIN DAVOODI AND JOSEPH YONAN/ADMINISTRATO/APPLICANT Interview Method: Telephone interview On 10/12/23, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisionsthe state’s words, verbatim · CDSS document, Oct 12, 2023