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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336426347
Report Date: 09/28/2022
Date Signed: 09/28/2022 11:49:12 AM


Document Has Been Signed on 09/28/2022 11:49 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:SILVER MOON ASSISTED LIVINGFACILITY NUMBER:
336426347
ADMINISTRATOR:APRIL GERONIMOFACILITY TYPE:
740
ADDRESS:35681 SILVERWEED ROADTELEPHONE:
(951) 926-0570
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY:6CENSUS: 5DATE:
09/28/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Marialucia Pareja/PollardTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced for the purpose of completing the facility's annual inspection. LPA Colvin met with caregiver Marialucia Pareja/Pollard and explained the purpose of LPA Colvin's visit.

Upon signing in on the visitor log, LPA Colvin observed the name of the facility on the log to be "Spencer's Crossing Senior Assisted Living". LPA Colvin inquired about the name being different from the name LPA Colvin had for the facility, and Marialucia Pareja/Pollard informed LPA Colvin that the name was changed and is reflected on their posted license. LPA Colvin looked at the license posted in the facility and confirmed the name and that the address matches this location. LPA Colvin looked up the name in the Licensing system and confirmed that there was a change of ownership and name for the facility, and that a new license was issued (#331881332), and that this old license needed to be closed. New license effective date was 8/18/22, and as of today, this facility license will be closed and only the new license will remain in effect. No annual is needed at this time due to the Pre-Licensing inspection for the new license having been completed in July 2022.

LPA Colvin conducted an exit interview with staff Marialucia Pareja/Pollard and a copy of this report was provided.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal ColvinTELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:
DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/28/2022
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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