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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197606341
Report Date: 09/26/2024
Date Signed: 09/26/2024 01:13:08 PM

Document Has Been Signed on 09/26/2024 01:13 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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:LILY OF THE VALLEYFACILITY NUMBER:
197606341
ADMINISTRATOR/
DIRECTOR:		NATALIA L. ESPINOFACILITY TYPE:
740
ADDRESS:8618 BOTHWELL ROADTELEPHONE:
(818) 993-7800
CITY:NORTHRIDGESTATE: CAZIP CODE:
91324
CAPACITY: 6CENSUS: 3DATE:
09/26/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:29 PM
MET WITH:Rody EspinoTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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In conjunction with annual inspection visit. LPAs Mariana Agban and Michael Cave conducted POC Visit. On 08/06/2024 the Licensee was cited for converting the garage to a room with a private bathroom without obtaining permits. During today's annual inspection, LPAs observed the room that was converted was demolished. Administrator confirmed that no staff or residents are residing at that room.

Exit interview conducted. POC is cleared and copy of this report signed and delivered.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2024
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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