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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197603165
Report Date: 03/19/2025
Date Signed: 03/19/2025 01:52:55 PM

Document Has Been Signed on 03/19/2025 01:52 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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:GLEN PARK AT VALLEY VILLAGEFACILITY NUMBER:
197603165
ADMINISTRATOR/
DIRECTOR:		MARILOU MENDOZAFACILITY TYPE:
740
ADDRESS:5527 LAUREL CANYON BLVDTELEPHONE:
(818) 769-6626
CITY:VALLEY VILLAGESTATE: CAZIP CODE:
91607
CAPACITY: 100TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
03/19/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:13 AM
MET WITH:David AnguiniaTIME VISIT/
INSPECTION COMPLETED:
01:34 PM
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Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced Case Management - Incident visit to follow up on a LIC 624 Incident report and SOC 341 received by the department on 03/12/2025. LPA Urena met with Executive Director (ED) David Aguiniga and Assistant Administrator (AA), Virginia (Gigi) Sumulong explained the reason for the visit.

On 03/12/2025, the Department received a LIC624 for Resident #1 (R1) and Resident #2 (R2) along with a SOC 341, both sent by facility staff. The report indicated that a Detective with the Los Angeles Police Department (LAPD) arrived at the facility to further investigate an incident that occurred on 03/06/2025, involving residents (R1 and R2).

At approximately 11:30 a.m., LPA Urena and the AA conducted a physical plant tour, obtained documents pertinent to the investigation (Video, staff and resident roster). LPA did not observe any immediate or potential health and safety concerns at this time. The ED was advised that the case was referred to the Investigation Bureau (IB). The LPA has determined further investigation is needed.



Exit interview conducted and copy of report issued.
Kasandra LopezTELEPHONE: (818) 596-4343
Sandra UrenaTELEPHONE: 747-230-3919
DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/19/2025
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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