Inspection visit

Routine inspectionAugust 15, 2023

VILLA VICTORIALicense 19860343915 citations on this visit

15 citations recorded

Inspector’s narrative

What the inspector wrote

Licensing Program Analysts (LPA) Alberto Lopez and Sanjay Vaid conducted an unannounced annual inspection at the facility. Upon arrival, LPA met with Staff Jermin Hendriette and Gloria M De Jesus and explained the purpose of the visit. LPA observed the following: Infection Control: The facility staff are using appropriate hand hygiene and gloves while assisting residents and medications. Disposals of trash are done immediately after changing a resident. Staff are still cleaning and disinfecting throughout the day. entrance. sufficient PPE supplies and has an Infection Control Plan posted by the entrance. Physical Plant & Environment Safety: The 1-story facility is not in good repair. Fire and carbon monoxide detectors are in every room and were operation. One can of Raid was accessible to residents and staff locked it up right away. Fire extinguisher is located at facility and serviced. Operational Requirements: The facility has plan to accept or retain clients with dementia. The facility does not have proof of enough liability insurance covering injury to residents and guest. The 1-story facility consist of the following: 5 Resident Bedrooms and 3 Resident Bathrooms, dining room, living room, TV room, and backyard area. Staffing : There appears to be sufficient staffing at the facility. The administrator’s INDRAWATI, YENNY certificate expired 12/17/2021. Staff employed are all over the age of 18. Personnel Records-Training : Staff files are maintained at the facility. Staff have current CPR/first aid training but no evidence of on-going training. Continued on 809C Resident Records-Incident Reports: Resident files are maintained at the facility and have the following documents in their files - Admission Agreements, other required documentation is missing from several resident files Residents Rights-Information: The Complaint poster and personal rights are posted by the main entry. Food Service: 7 days non perishable food is not sufficient. Incidental and medical services: Medication files were reviewed for 4 residents and some PRN are missing labels and PRN authorization labels. Also, some residents had medications in their rooms. Planned Activities: Facility has not activities planned. Disaster Preparedness: The facility does not have an Emergency Disaster Plan posted with contact numbers and at least 2 relocation sites. Resident with Special health needs: Some residents may be bedridden and no documentation to prove otherwise. During the visit today, LPAs observed deficiencies and are indicated on the LIC809D. Deficiencies cited (See 809D) and technical advisories was also provided. An exit interview was held. A copy of this report, LIC809D, technical advisory notes, and appeal rights were given to Staff Jermin Hendriette and Gloria M De Jesus

Citations

15 citations recorded^*CCLD

What does Type A vs Type B mean?

Type A. Serious citation. Imminent or substantial risk to children. The regulator requires corrective action immediately and may impose a civil penalty.

Type B. Lower-severity citation. Corrective action required, no imminent risk. The regulator monitors compliance on the next visit.

1569.605Type B
Based on record review, the licensee did not comply with the section cited above. Facility did not have proof of liability insurance which poses/posed a potential health, safety or personal rights risk to persons in care.
1569.618(b)(3)Type B
Based on interview the licensee did not comply with the section cited above . Administrator is at facility only one hour or two per week and has no offical designated substitute. which poses/posed a potential health, safety or personal rights risk to persons in care.
1569.695(c)Type B
Based on interview, record review, the licensee did not comply with the section cited above. Facility has not had an emergency drill which poses/posed a potential health, safety or personal rights risk to persons in care.
87202(a)Type A
Based on observation, interview, the licensee did not comply with the section cited above. Facility has 3 bedridden residents and no fire clearance for that poses an immediate health, safety or personal rights risk to persons in care.
87208(a)Type B
Based on record review, the licensee did not comply with the section cited above. Facility had not plan of operation on file which poses/posed a potential health, safety or personal rights risk to persons in care.
87303(a)Type B
Based on observation, interview the licensee did not comply with the section cited above. The clothes dryer and AC is not working which poses/posed a potential health, safety or personal rights risk to persons in care.
87303(a)(1)Type B
Based on observation, interview, the licensee did not comply with the section cited above. Ramp in hall wall is in need of repair or replacement which poses/posed a potential health, safety or personal rights risk to persons in care.
87309(a)Type A
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above. Raid canister was accessible to residents which poses an immediate health, safety or personal rights risk to persons in care.
87458(a)Type A
Based on record review, the licensee did not comply with the section cited above. Four residents did not have LIC602 which poses an immediate health, safety or personal rights risk to persons in care.
87465(h)(2)Type A
Based on observation, the licensee did not comply with the section cited above. Medications were accessible to residents and in their rooms which poses an immediate health, safety or personal rights risk to persons in care.
87555(b)(26)Type A
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above. Facility does not have 7 days nonperishable food on hand which poses an immediate health, safety or personal rights risk to persons in care.
87555(b)(27)Type A
Based on observation, the licensee did not comply with the section cited above roaches were observed in kitchen cabinets which poses an immediate health, safety or personal rights risk to persons in care.
87633(h)Type A
Based on record review, the licensee did not comply with the section cited above. Their is no record of residents which receive hospice which poses an immediate health, safety or personal rights risk to persons in care.
87705(c)(5)Type B
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above. No residents with dementia had annual assessments which poses/posed a potential health, safety or personal rights risk to persons in care.
87705(f)(1)Type A
Based on observation, the licensee did not comply with the section cited above. LPAs observed knifes in kitchen accessible to residents which poses an immediate health, safety or personal rights risk to persons in care.

FAQ · About this visit

Common questions about this visit

What happened during the August 15, 2023 inspection of VILLA VICTORIA?

This was a inspection inspection of VILLA VICTORIA on August 15, 2023. 15 citations were issued: 8 Type A (serious) and 7 Type B.

Were any citations issued to VILLA VICTORIA on August 15, 2023?

Yes, 15 citations were issued (8 Type A, 7 Type B). The first citation was for: "Based on record review, the licensee did not comply with the section cited above. Facility did not have proof of liabili..."

What type of inspection was this?

This was a inspection inspection. inspection inspections are conducted by CCLD as part of their licensing oversight.

SourceView on CCLD View original report

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Data from CCLD public records. Last updated May 25, 2026. If you believe any information is inaccurate, report it here.

Routine inspection·August 15, 2023