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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336425690
Report Date: 09/08/2021
Date Signed: 09/08/2021 04:33:59 PM

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:MORNING GLORY SENIOR CAREFACILITY NUMBER:
336425690
ADMINISTRATOR:LUCENA, EFRENFACILITY TYPE:
740
ADDRESS:11327 MORNING GLORY COURTTELEPHONE:
(951) 840-4182
CITY:RIVERSIDESTATE: CAZIP CODE:
92503
CAPACITY:6CENSUS: 0DATE:
09/08/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Efren Lucena, AdministratorTIME COMPLETED:
04:45 PM
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Licensing Program Analyst Yolanda Delgado made an unannounced visit to conduct a Complaint visit for illegal eviction. LPA was met by Efren Lucena, Administrator and was welcomed into the facility. Administrator Efren stated that he closed the facility on September 7, 2021 when the last resident moved out. Administrator stated they had 6 residents. LPA requested the relocation and contact information for each resident to verify the relocation. LPA has verified two (2) of six (6) residents relocation at Gold Living Home Care, facility is licensed with CCLD. Administrator will obtain the additional information for the remaining four (4) residents. LPA has verified no one is in care at the facility and Licensee has surrendered the copy of the license to the LPA.
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Yolanda DelgadoTELEPHONE: (951) 203-0337
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021
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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