<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881102
Report Date: 03/17/2022
Date Signed: 03/18/2022 11:29:33 AM


Document Has Been Signed on 03/18/2022 11:29 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:PRUDENCE SENIOR LIVINGFACILITY NUMBER:
331881102
ADMINISTRATOR:GOFFUR, EFAZFACILITY TYPE:
740
ADDRESS:23595 TAFT COURTTELEPHONE:
(951) 742-1742
CITY:MURRIETASTATE: CAZIP CODE:
92562
CAPACITY:6CENSUS: 0DATE:
03/17/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:--TIME COMPLETED:
02:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPAs) Javina George and Venus Mixson conducted a case management visit to confirm facility closure.

On 03/07/22 LPA received an email from the Licensee Efaz Goffur stating that He was no longer interested in having the business, as the facility received zero (0) admissions and had staff that were willing to work.

LPAs met with the current tenants, whom stated that they moved into the home a month and a half ago, and that the house was on the market for at least 7 months or so.

Per the current tenants the home is no longer a congregate care facility, and has said that people have come by to draw blood, but they have been turned away as they only ones residing in the home are he his wife and children.

LPAs were granted entry and did not observe any residents. The residence did not have any indication of elderly resident's residing in the home. As evidenced by family portraits, decor for children as well as toys, and no other adults present other than the tenants.

The facility will have an official closure date of 03/17/2022. A copy of this report will be mailed to the Licensee's mailing address and sent to the email on file.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:
DATE: 03/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/17/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1