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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565800182
Report Date: 06/28/2024
Date Signed: 06/28/2024 09:54:43 AM


Document Has Been Signed on 06/28/2024 09:54 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:ST. PAUL'S R.C.F.E.FACILITY NUMBER:
565800182
ADMINISTRATOR:MALARI MARILOUFACILITY TYPE:
740
ADDRESS:2292 GODDARD AVETELEPHONE:
(805) 581-9457
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93063
CAPACITY:5CENSUS: 0DATE:
06/28/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Marilou MalariTIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced Case Management-Other visit to the above facility.  LPA met with Administrator, Marilou Malari as the purpose of the visit is to conduct a final walk-through of the facility prior to closure.  Entrance interview conducted.

On 05/28/2024, the Administrator contacted  the Regional Office in Woodland Hills to inform the Department of the intent to close the facility.  On 04/22/2024 the facility notified and issued written notices to residents residing at the facility. As of 05/22/2024, (3) residents have relocated to St. Paul's Home Care II #56580068's and (1) to St Mary's Home Care #565800680

During today’s visit, LPA observed facility to be vacant and verified that no care and supervision was being provided.  Administrator surrendered License to LPA.  The facility will be closed effective June 28, 2024, in the Licensing Information System (LIS).

Exit interview conducted.  A copy of the report was issued.
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian BalisiTELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:
DATE: 06/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/28/2024
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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