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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336400701
Report Date: 10/30/2024
Date Signed: 10/30/2024 11:57:10 AM

Document Has Been Signed on 10/30/2024 11:57 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:MORENO VALLEY GUEST HOMEFACILITY NUMBER:
336400701
ADMINISTRATOR/
DIRECTOR:		FRANCISCO, GLORIA J.FACILITY TYPE:
735
ADDRESS:14621 VICTOR DRIVETELEPHONE:
(951) 379-0305
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92553
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
10/30/2024
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:15 AM
MET WITH:Michael CurryTIME VISIT/
INSPECTION COMPLETED:
12:10 PM
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On October 30, 2024, Licensing Program Analysts (LPAs), Abdoulaye Zerbo and Armando Perez made an announced visit for the purpose of conducting the final facility closure visit. LPAs were greeted and granted entry by the Administrator Michael Curry.

The department learned of the closure on October 29,2024 when attempting to conduct an annual required visit. According to Licensee, the reason for closure is due to the low census of the facility. During today's visit, LPAs toured the interior and exterior of facility with Administrator Michael Curry, and observed all bedrooms to be vacant, there were no residents residing in the home and no staff scheduled to be working. All the residents have been relocated and LPA Zerbo confirmed the relocation of each of the 3 out of 3 residents by calling the facilities.

The Administrator surrendered their original License on October 30,2024 (Effective Date: October 30,2024). The LPAs explained to Administrator that the license will no longer be valid, and therefore no required care and supervision should be provided in the home unless the state approves licensure in the future.

An exit interview was conducted, and a copy of this report was provided to the Administrator Michael Curry.

Rikesha StampsTELEPHONE: (951) 212-0616
Abdoulaye ZerboTELEPHONE: (951) 248-2222
DATE: 10/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/30/2024
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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