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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336408352
Report Date: 08/04/2022
Date Signed: 08/04/2022 03:01:18 PM

Document Has Been Signed on 08/04/2022 03:01 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:LUCENA ADULT RESIDENTIAL FACILITYFACILITY NUMBER:
336408352
ADMINISTRATOR:NENITA LUCENAFACILITY TYPE:
735
ADDRESS:24782 HEIL DRIVETELEPHONE:
(951) 208-4416
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92553
CAPACITY: 6CENSUS: 1DATE:
08/04/2022
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Vanessa Lucena, LicenseeTIME COMPLETED:
10:15 AM
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Licensing Program Analysts (LPAs) Tricia Danielson and Venus Mixson arrived unannounced to the facility to conduct a collateral visit to conduct interviews for a matter which did not occur at this facility. LPAs met with Licensee Vanessa Lucena.

During today's visit, LPAs interviewed Lucena and Resident #1 (R1).

An exit interview was conducted and a copy of this report was provided along with LIC811 - Confidential Names List.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Tricia Danielson
LICENSING EVALUATOR SIGNATURE: DATE: 08/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/04/2022
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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