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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610346
Report Date: 06/11/2024
Date Signed: 06/11/2024 02:52:21 PM


Document Has Been Signed on 06/11/2024 02:52 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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364



FACILITY NAME:BLESSED SENIOR LIVING CARE LLCFACILITY NUMBER:
197610346
ADMINISTRATOR:VALDES, JENNIFERFACILITY TYPE:
740
ADDRESS:3244 ASHTON PLACETELEPHONE:
(818) 813-4403
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:6CENSUS: 0DATE:
06/11/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Jennifer Valdes (via telephone)TIME COMPLETED:
03:00 PM
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At 1:30 p.m., Licensing Program Analyst (LPA) Evelin Rios, conducted a Case Management visit to confirm the closure of this facility and to follow up with a plan of correction developed on 05/24/2024. Administrator agreed to submit a copy of the 60 day notification provided to residents and their responsible person(s) by May 29, 2024. As of today administrator has not provide a copy of the 60 day eviction notification to LPA.

LPA knocked on the door, an individual answered the door and stated they were hired by the home owner to work on repairs in the house. The individual also stated the house is currently vacant and he is not a tenant. Individual refused to provide their name. LPA contacted the landlord (not the licensee or administrator) and they corroborated the facility is no longer operating and confirmed the previous tenant (licensee and administrator) removed all the furniture sometime last week. Prior to this case management visit LPA contacted residents’ responsible party and confirmed all residents had moved out of the facility on 05/25/2024. LPA contacted the administrator Jennifer Valdes by telephone. Administrator stated she will be unable to meet LPA in person. Administrator also stated they have not been able to work on the 60 day notifications and stated they may be able to complete them next week.

LPA was able to confirm that there were no residents residing in the facility and that operation has ceased on on todays visit. The reason for closure of the facility is financial difficulty maintaining the facility operational. Administrator has already surrendered the License to LPA Rios.

LPA reminded administrator there is an open complaint and the Woodland Hills South Regional Office will be in contact when more information becomes available. LPA has confirmed mailing address with administrator.

(Continued on to LIC809-C)
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Evelin RiosTELEPHONE: 424-299-6104
LICENSING EVALUATOR SIGNATURE:
DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/11/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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: BLESSED SENIOR LIVING CARE LLC
FACILITY NUMBER: 197610346
VISIT DATE: 06/11/2024
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 Administrator had expressed they would like to some day submit a new application for a licensed facility as a non-profit. LPA discussed with the administrator based on this information the Woodland Hills South Regional Office may plan to meet with the facility administrator and licensee via an office visit.

LPA Rios will submit the file for closure upon returning to the Woodland Hills South Regional Office.

LPA will e-mail the closure survey to administrator's email on file.

Civil penalty assessed for failure to meet Plan of Correction due date (refer to LIC421FC). Exit Interview conducted, appeal right emailed, copy of this report emailed to administrator for signature.

SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Evelin RiosTELEPHONE: 424-299-6104
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024
LIC809 (FAS) - (06/04)
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