Lilly of the Valley Divine Home

Type of visit: Case Management - Other

On 6/12/2026 at 9:10am, Licensing Program Analyst (LPA) Perry Scott conducted a case management visit to follow up on deficiencies that were found during a pre-licensing inspection visit conducted on 05/15/2026. LPA met with applicant Lilian Ndukwe and the purpose of the visit was explained. The following items required a follow up inspection for verification of correction before being licensed: · Gas line needs to be turned on prior to licensing. · Bedrooms #1 and #2 needs to have a chest of drawers. · Bedroom #2 has a broken mirror on the closet door that needs to be replaced. · First aid manual is required. · A whole in the garage above the washer and dryer needs to be fixed. · Remove broken pots/bricks and on-going construction material in the backyard and on the side of the house. · Home needs at least a two-day supply of perishable food. Report Continued On LIC809-C During the case management visit the department observed that all deficiencies were corrected, and no items require a follow up inspection for verification of correction. Pre-Licensing is complete, and this facility has no deficiencies. The department will submit a copy of this Facility Evaluation Report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application. An exit interview was conducted, and a hard copy of this Facility Evaluation Report has been furnished to the applicant, Lilian Ndukwe.the state’s words, verbatim · CDSS document, Jun 12, 2026

Type of visit: Prelicensing

On 05/15/26, at 9:00am, Licensing Program Analyst (LPA) Perry Scott conducted an announced visit to Lilly of the Valley Divine Home. LPA was greeted by applicant, Lilian Ndukwe. LPA explained the purpose of today’s pre-licensing inspection visit. The applicant has an administrator’s certificate (7031572740) which is valid from 10/10/2025 through 10/09/2027 for a Residential Care facility for the Elderly. An application was submitted to Community Care Licensing Division (CCLD) on 03/13/25 in the initial license application for a Residential Care Facility for the Elderly. The applicant requested a capacity of six (6) ambulatory adults (aged 60 and over); with an approved hospice waiver for six (6) residents. A fire clearance was approved for six (6) ambulatory residents only. Structure: The home is a three (3) bedroom, two (2) bathroom, single-story home with an attached garage situated in a residential neighborhood. The home includes a living room, kitchen, and laundry area in the garage. The living area included table, sofa, couch, chairs, and a television. The kitchen has a refrigerator, stove, and microwave. The rear exterior is fenced throughout with a patio that includes a table, and chairs. The passageways in the backyard has ongoing construction that needs to be removed prior to licensing. Report Continued On LIC809-C Bedrooms for Residents: The home has three (3) bedrooms. All rooms include two (2) full-size beds, one (1) chair, one (1) night stand, and table lamps. All bedrooms are equipped with ceiling lighting, and a dresser in one room. All rooms have closets with ample storage space. Bedrooms #1 and #2 are missing a chest of drawers in each room. Bedrooms for Staff: There is no bedroom designated for live-in staff. Bathrooms: The home has two (2) bathrooms. All bathrooms have a working toilet, washbasin, shower/tub with grab bars, and non-skid mats. Linens & Hygiene Supplies: Beds have the required linen supplies which include pillowcases, mattress pads, fitted sheets, blankets, and bedspreads. An adequate supply of linen is stored in the hall storage area. Emergency Phone Numbers, Exit Plan & Menu: The emergency disaster plan is posted along with the exit plan. There is one (1) fire extinguisher located in the kitchen area. The facility has land line telephone located in the living room. The applicant has submitted a mitigation plan. Food Service: Dishes, cups, and flatware are stored in the kitchen cabinets, inspected, and in good repair. Knives, cutlery, and other sharp kitchen utensils are stored in a locked cabinet. Food supply is adequately stored in kitchen cabinets and consists of can and other dry goods. The facility has nonperishable foods for a minimum of one week but does not have any fresh perishable foods for a minimum of two days that were observed. Smoke Detectors: Smoke and carbon monoxide detectors are located throughout the interior space and bedrooms and are working properly. Report Continued On LIC809-C Toxins & Kitchen: All toxins are locked and stored in the supply closet. Stove burners and oven were not working because the home needs to have the gas turned on. Washer and dryer were working. There is one (1) refrigerator in the kitchen. The refrigerator measured a temperature of at least 45 degrees Fahrenheit for appropriate food storage. The home is equipped with central air and heating. Water Temperature: The hot water temperature could not be measured because the home needs to have the gas turned on. Medications, First-Aid Kit & Book: First aid kit was stored in the supply closet but was missing an approved first aid manual. The first aid kit contained the following: thermometer, tweezers, scissors, antiseptic, bandages, and gauze medication cabinet that is locked and inaccessible to residents. The residents’ medications will be stored in a locked supply closet. Resident & Staff Files, Reading Material, Games: Records for staff and residents will be stored in a safe in the supply closet. The home has board games, books, magazines, and other recreational materials for the residents. Pool/Jacuzzi & Pets: There are no pets, jacuzzi, or pool at the home. Fire clearance: A fire clearance inspection was conducted on 04/17/2026 and approved for a capacity of six (6) ambulatory residents only. LPA did not observe pad locks or other mechanisms which may be obstructions for safe and quick egress during an emergency on the front and back exits. Report Continued On LIC809-C Component III: LPA and the applicant completed the Component III PowerPoint presentation, which gives an overview of what to expect while running a residential care Facility for the Elderly. During the pre-licensing inspection there were items observed which do not comply with applicable laws and regulations. The following items require a follow up inspection for verification of correction before being licensed: · Gas line needs to be turned on prior to licensing. · Bedrooms #1 and #2 needs to have a chest of drawers. · Bedroom #2 has a broken mirror on the closet door that needs to be replaced. · First aid manual is required. · A whole in the garage above the washer and dryer needs to be fixed. · Remove broken pots/bricks and on-going construction material in the backyard and on the side of the house. · Home needs at least a two-day supply of perishable food. Pre-Licensing is not complete, and this facility has deficiencies which require a subsequent visit for proof of correction. The department will submit a copy of this Facility Evaluation Report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application. An exit interview was conducted, and a hard copy of this Facility Evaluation Report has been furnished to the applicant, Lilian Ndukwe.the state’s words, verbatim · CDSS document, May 15, 2026

Type of visit: Office

COMP II by CAB successfully completed Facility Type: RCFE Application Type: INTL Capacity: 6 Census : 0 Method: Telephone call with CAB COMP II Participants: Ndukwe, Lilian (Licensee & Administrator), & Dianna Esparza (Analyst). Licensee & administrator participated in COMP II via Telephone call with CAB Analyst. Identification of licensee/administrator was verified by confirming driver’s license numbers. During COMP II, licensee/administrator confirmed the understanding of Title 22. Component II was successfully completed. Licensee/administrator were advised to email signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed licensee's/administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Apr 13, 2026