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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610372
Report Date: 11/05/2025
Date Signed: 11/05/2025 04:17:03 PM

Document Has Been Signed on 11/05/2025 04:17 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: 3DATE:
11/05/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:46 PM
MET WITH:Elbert PerezTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
NARRATIVE
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On 11/05/25 Licensing Program Analyst (LPA) Lorena Casillas met with staff member Elbert Perez for a case management visit. The purpose of the case management visit is to address deficiencies observed during the course of investigation for complaint # 31-AS-20251030092102. The deficiencies were not alleged but are related to the complaint. Administrator was not able to meet with LPA and assigned staff member Elbert Perez to sign the report.

During the facility file review LPA was not able to locate a facility file for Staff #1 (S1). LPA searched the Guardian website to verify the facility roster and could not locate S1 on the Guardian website. Due to no facility file on S1, LPA was not able to search and check if S1 has a current fingerprint clearance. Interview with Staff #2 stated that S1 covered for them on 10/31/25, however interview with Resident #1 (R1) revealed that S1 had been at the facility for about a month. LPA expressed to Administrator the importance of making sure that staff is fingerprint cleared and associated to the facility prior to working and providing direct care and supervision. A civil penalty will be issued. Administrator was also advised that all staff have to have a facility file and it needs to be readily available for review. A citation will also be issued for not having a file for S1.

Citations issued. Exit interview conducted. Copy of report provided to designee.

NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Lorena Casillas
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/05/2025
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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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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Document Has Been Signed on 11/05/2025 04:17 PM - It Cannot Be Edited


Created By: Lorena Casillas On 11/05/2025 at 03:48 PM
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
, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: WILLOWVIEW HOME TWO, LLC
FACILITY NUMBER: 197610372

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/05/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/06/2025
Section Cited
CCR
87355(e)(2)

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Criminal Record Clearance(e)All individuals subject to a criminal record review... Health and Safety Code Section 1569.17(b) shall prior to working... in a licensed facility(2)...California clearance or a criminal record exemption ...This was not met as evidenced by:
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Administrator will submit a written letter via email to LPA that going forward they will adhere to the cited regulation. Administrator also agree to not having S1 return to the facility until a clearance and association is obtained.
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Based on interviews and record reviews the licensee failed to have a crominal record clearance for S1. This poses an immediate health, safety and personal rights risk to residents in care.
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Type A
11/06/2025
Section Cited
CCR87412(a)(1)-(13)

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Personnel Records (a)The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: ...(1)-(13)...This was not met as evidenced by:
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Administrator will submit a written letter by the POC due date stating that they will review Title 22 Division 6 Chapter 8 of the CA Code of Regulations 87412 Personnel Records and that going forward will adhere to these regulations. Administrator will also complete a file for S1 by POC due date.
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Based on interviews, observations and file review the licensee failed to have a staff file for S1. this poses an immediate health, safety and personal rights risk to residents 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.
Nichelle Gillyard
NAME OF LICENSING PROGRAM MANAGER:
Lorena Casillas
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 11/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/05/2025


LIC809 (FAS) - (06/04)
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