331881492-3-5-2026-18-AS-JTOS-DRW2CF-20260305161641

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 331881492
Report Date: 03/05/2026
Date Signed: 03/05/2026 04:17:22 PM

Document Has Been Signed on 03/05/2026 04:17 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	LUCENA ARF #2		FACILITY NUMBER:	331881492
ADMINISTRATOR/ DIRECTOR:	LUCENA, VANESSA		FACILITY TYPE:	735
ADDRESS:	14497 PHILO ST		TELEPHONE:	(951) 330-1991
CITY:	MORENO VALLEY	STATE: CA	ZIP CODE:	92553
CAPACITY: 4		CENSUS: 0	DATE:	03/05/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:50 PM
MET WITH:	Administrator, Anthony Alonzo		TIME VISIT/ INSPECTION COMPLETED:	04:20 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	On March 5, 2026, Licensing Program Analyst (LPA), Jarred Torres, arrived at the facility unannounced to conduct an annual inspection and met with Anthony, Anthony Alonzo. A facility file review was conducted at the regional office and additional records were requested and reviewed at the facility. Their files were stored and maintained digitally. The facility is licensed for four adults and was operating at a census of zero adults. The administrator stated that the census is currently at zero because they have no vendors with the Inland Regional Center, so they have not been able to get clients placed here. LPA Torres toured the facility along with Anthony and made observations pertaining to the annual inspection. The LPA inspected the facility inside and outside. There were no obstructions to the indoor and outdoor passageways at the time of this visit. Additionally, there were no bodies of water on the premises. The single-story home was located at 14497 Philo Street, Moreno Valley, CA 92553. During the tour of the premises, the LPA observed the facility phone to not be operational. The facility's phone number is 951-214-2856. Anthony stated they will contact the phone company to fix the phone before clients are accepted. The LPA observed the bedrooms which were equipped with the required furniture as stated in Tittle 22 of the California Code of Regulations (CCR). All bedrooms were unoccupied by clients since there are no clients accepted into the facility at the time of this inspection. The facility's appliances were observed to be operational at the time of this visit. The facility is equipped with operational smoke detectors and a carbon monoxide detector. The fire extinguisher was in good condition and was serviced on 7/10/25. Required postings regarding safety, personal rights, and emergency exits were posted in the home. The facility has a designated area for sharps and chemicals, which were kept locked. Continued on LIC 809-C...

NAME OF LICENSING PROGRAM MANAGER: Jazmond D Harris
NAME OF LICENSING PROGRAM ANALYST: Jarred Torres
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/05/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: LUCENA ARF #2	FACILITY NUMBER: 331881492
	VISIT DATE: 03/05/2026

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The furniture in the facility was in good condition. The facility's cooling and heating system is operational and the air temperature was at 74 degrees Fahrenheit(F) and the hot water was measured at 138 degrees F. The facility has appropriate signage to warn people about the hot water.

The LPA did not observe any medications because there were no clients in care.

In the kitchen, there was no dust nor debris. The facility has no clients, so the food supply was adequate for a census of zero.

Adequate staff was present for the supervision of zero residents in care. The facility has a designated area for storing activity supplies and activities will be conducted in the living room. Floor plans and telephone numbers were displayed in the facility. Anthony had a valid administrator's certificate on file, which expires on 9/19/27, and Vanessa Lucena had a valid administrator's certificate on file, which expires on 12/17/27.

The staff files were current, which includes, but is not limited to, TB tests showing a negative result, completed trainings, and valid first aid certifications. There were no discrepancies observed during the file review. Client files were not reviewed because the census is zero, and the LPA observed that no clients are living here.

The LPA reviewed the emergency disaster plan and fire clearance, and the emergency disaster plan meets the department's standards.

The LPA inspected and observed the bathrooms and hand washing stations which were free of dust and debris. Additionally, the facility has an approved infection control plan in their files.

No health or safety issues were observed at the time of the visit.

As it relates to the phone not being operational, a Technical Violation was issued and signed by Anthony.

An exit interview was conducted and this report was reviewed with the Administrator. A copy of this report was provided to the Administrator whose signature confirms receipt.

NAME OF LICENSING PROGRAM MANAGER: Jazmond D Harris
NAME OF LICENSING PROGRAM ANALYST: Jarred Torres
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/05/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026

LIC809 (FAS) - (06/04)

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