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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610372
Report Date: 01/07/2025
Date Signed: 01/07/2025 12:13:26 PM

Document Has Been Signed on 01/07/2025 12:13 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:WILLOWVIEW HOME TWO, LLCFACILITY NUMBER:
197610372
ADMINISTRATOR/
DIRECTOR:		ANGUIANO, EMALYNFACILITY TYPE:
740
ADDRESS:44148 12TH ST WESTTELEPHONE:
(661) 418-6180
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY: 6CENSUS: 0DATE:
01/07/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Kim Vivar -Facility RepresentativeTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On 1/07/2025 at approximately 09:30 AM, Licensing Program Analyst (LPA), Angelica Segovia conducted an unannounced annual visit to the facility. Upon arrival LPA rang the doorbell which Administrator Emalyn Anguiano responded through the video “Ring” doorbell. LPA stated the reason for their visit. The Administrator stated she is not available for today’s visit, and they have zero (0) residents currently. The Facility Representative Kim Vivar arrived shortly after to assist with today’s visit.

LPA asked for census and insurance. LPA conducted a physical plant tour at approximately 11:15 AM and the following was noted:

There is only one entrance being utilized at the facility. The facility is a single unit building with four (4) bedrooms and two (2) bathrooms currently occupying zero (0) residents. One (1) staff room located in approved conversion of garage. The facility has approved fire clearance for six (6) residents of which four (4) may be ambulatory and two (2) non-ambulatory. Hospice waiver approved for six (6).

Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. Required postings such as See/Say Something, Long-Term Ombudsman, and Resident’s Rights were located upon entrance.

Common areas: Living room and dining room observed to be neat, clean, and organized. Common areas observed to be properly furnished and in good repair. The facility maintains a comfortable temperature at 70°F. Fire extinguisher located in the kitchen and dated 03/04/24.

Kitchen: Kitchen observed to be clean and inaccessible to pests. Knives and sharps observed to be locked in kitchen drawer inaccessible to residents. Cleaning solutions and toxins observed locked underneath kitchen sink (continued on LIC 809-C)

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE: DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/07/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: WILLOWVIEW HOME TWO, LLC
FACILITY NUMBER: 197610372
VISIT DATE: 01/07/2025
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Backyard: The backyard of the facility is equipped with a designated shaded area with outdoor furniture for residents. There is no body of water in this facility. Locked storage unit observed.

Smoke detectors and carbon monoxide observed to be working properly and were tested.

Garage: The garage was converted into a room and is shown on approved facility sketch. It is also being used for staff reception area, extra storage, and staff room. The converted unit can be accessed from inside the facility and kept locked inaccessible to residents.

Laundry Room: The laundry room is located inside the converted unit alongside staff room.

Bedrooms: The Residents' rooms are adequately furnished with appropriate furniture and lighting system. Hallways/passageways are lighted appropriately. The bathrooms were checked for cleanliness and proper operation. The hot water temperature was measured within regulations at 111.0°F. Appropriate grab rails and skid mats were observed and in proper condition.

Medications: Medication logs and facility files kept stored in locked closet leading towards the kitchen inaccessible to residents. First-aid kit observed to be equipped with but not limited to bandages, scissors, digital thermometer, tweezer, and manual.

Resident records: There are zero (0) residents. Administrator stated both residents were moved to different facilities.

There was no immediate health and safety hazard observed during the day of inspection. Exit interview conducted and a copy of this report was provided to the Facility Representative.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025
LIC809 (FAS) - (06/04)
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