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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609358
Report Date: 09/12/2024
Date Signed: 09/12/2024 10:29:31 AM

Document Has Been Signed on 09/12/2024 10:29 AM - 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.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:VILLA DE SOFIA RETIREMENT HOMEFACILITY NUMBER:
197609358
ADMINISTRATOR/
DIRECTOR:		GARCIA, NEMIAFACILITY TYPE:
740
ADDRESS:4139 TERRA VERDE DRIVETELEPHONE:
(661) 265-0146
CITY:PALMDALESTATE: CAZIP CODE:
93552
CAPACITY: 6CENSUS: 0DATE:
09/12/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:28 AM
MET WITH:Nemia Garcia - AdministratorTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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Licensing Program Analysts (LPAs) Gary Tan and Angelica Segovia conducted an announced case management visit to this facility to ensure that the facility had ceased operation. LPA met with administrator Nemia Garcia and state the purpose of the visit.

The reason for today's visit is to document the closure of the facility which was initiated by the Licensee. The Licensee surrendered this facility's license to Community Care Licensing Division (CCLD) on 09/04/24. All the residents were removed and placed to another facility on 08/27/24 and 09/01/24.

During today's visit, the LPA conducted physical plant tour at 9:45 AM with the administrator and observed that there is no more resident currently living in the facility and the house is already empty. LPAs' interview with the administrator confirmed that the facility will now become the primary resident of her family. All the former residents' room are vacant, and the garage was also vacant. This closure will take effect today.

Exit interview conducted. A copy of today's report was issued.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE: DATE: 09/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/12/2024
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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