Serene Life Senior Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jose Tan, met with Administrator Rima Abelian for a One (1) Year Required visit for this facility. LPA explained the reason for the visit. A tour of the physical plant was conducted at 12:22 PM and the following was noted: There is only one entrance being utilized at the facility. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. The facility had submitted and approved Infection Control and Mitigation plan. The facility has a designated visitors' area at the backyard. The facility has a total of four (4) bedrooms and three (3) bathrooms. One (1) of the bathroom is designated for staff use only. The facility is fire cleared for six (6) non ambulatory residents, one (1) of which maybe bedridden on Room #3. Hospice Waiver for two (2) residents. KITCHEN: The facility has a Kitchen that is equipped with a refrigerator, microwave, stove, dishwasher and sink. There was an adequate supply of perishable and nonperishable food. Knives were observed locked in a kitchen drawer. Cleaning supplies and other toxins are stored in the cabinet in the bedroom hallway which was locked during visit. BEDROOMS: There are three (3) shared bedrooms for clients' use and two (2) bedroom for designated for staff use. The residents' bedrooms are furnished with beds, night stand, chairs, dressers, bedding and linen and have sufficient lighting and storage. (continued on LIC 809-C) (continued from LIC 809) BATHROOMS: The facility has three(3) bathrooms, two (2) are designated for staff use only. The bathroom was observed to have the proper fixtures, grab bars, and non-skid mats. The hot water temperature was measured at 105.6°F. LAUNDRY ROOM: The laundry room is located adjacent to the kitchen. Laundry detergents and other cleaning agents were locked in a cabinet in the laundry area. The cleaning supply cabinet was observed to be locked during visit. COMMON AREAS: These included the living room and the dining area. Living room was furnished with chairs and side tables. The living room area was furnished with a television. There was no visible immediate hazards. Dual smoke/carbon monoxide alarms were tested and observed to be operable. Fire extinguisher was last serviced on 01/22/25 and located in the dining room area. The facility is equipped with closed circuit television system in the outside surroundings and common areas only. MEDICATIONS: The medication cabinet is located in the bedroom hallway adjacent to the living room and observed to be locked during visit. A complete first aid kit is located in the kitchen. Resident Records: All residents record were reviewed and observed to be complete and updated. Staff records were also reviewed and observed to be complete and updated. SURROUNDING GROUNDS: The driveway, passageways and entrance to the home was clear of obstruction. All entry and exit doors have a functional auditory alert when the doors open. The front yard of the facility has a covered patio and outdoor furniture to accommodate the residents. The Garage is currently being used as frozen foods, PPE and other supplies storage. There are two (2) tool shed on the backyard separated by a 5' gate and inaccessible to residents. There is a drive way in side of the facility which could park three (3) cars at a time. There is no body of water in the facility. Disaster drill was last conducted on 07/01/25. Required posting observed in facility (complaint hot line poster). Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Sep 14, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Leizl de la Cerra, conducted an unannounced annual inspection at the facility mentioned above. At 10:45am LPA was greeted by the Administrator and LPA explained the reason for the visit. Administrator granted LPA access to the facility. At 11:15am, LPA conducted a tour of the facility and the following was observed: Bedrooms: The facility has a total of five (5) bedrooms. Three (3) bedrooms are designated for the residents. LPA observed all bedrooms are properly furnished and clean. The beds have appropriate bedding and linens. All rooms have sufficient lighting. Bathrooms: LPA observed all bathrooms to be clean and in good repair. Well stocked with toilet papers, soap and paper towels. LPA observed the appropriate grab bar and non-skid mat. LPA observed appropriate hand washing signs posted in each bathroom. All trash cans observed to have fitted lids to protect from cross contamination. The hot water temperature measured at 107°F. Common Areas: The facility maintains a comfortable temperature at 73°F. The living room and dining area appeared clean and were properly furnished. No obstructions and or tripping hazards observed. There is a fire extinguisher by the dining area observed to be operational. Kitchen: The kitchen appliances were functional. The kitchen has a working gas stove, faucet, freezer, refrigerator, and microwave. LPA found enough food for at least three (3) days perishable and seven (7) days non-perishable food at the facility that is properly stored. Knives were stored in a locked drawer in the kitchen. Food preparation areas are clean. Garbage cans have tight fitting covers. Kitchen cleaning supplies were stored in a locked cabinet. Laundry Area: This is located by the kitchen area. There is a functioning washer and dryer. Laundry detergents and cleaning solutions were stored in locked cabinets. CONTINUE to LIC809C Residents Records: LPA reviewed files for six (06) out of six (06) residents. Files are maintained at the facility in a locked room. Medications were reviewed for one(01) resident to confirm medication is given as prescribed and is documented properly. The facility uses the Medication Administration Record (MAR) log to document medications given. Medications are administered as prescribed by the Physician. Medications are bubbled packed. Medications are in a locked cabinet attached to a wall. Smoke detectors/carbon monoxide. Smoke detectors were located throughout the facility, and they were tested and observed to be operational. Carbon monoxide was located by the entrance and was also tested and observed to be operational. Outside areas: At approximately, 11:55am LPA toured the outside area of the facility. LPA observed appropriate outdoor furniture, with a covered shaded area for residents. LPA observed three sheds at the back separated by a vinyl fence. LPA observed the fence was locked and inaccessible to residents in care. All sheds locked and inaccessible to clients in care. All sheds are used for an extra storage. There are no bodies of water at this facility. Garage: Detached garage was located in the back of the facility and kept locked and inaccessible to residents. Extra PPE supplies and food storage was also observed. Operational Requirements: Liability Insurance policy is valid and will expire on 07/09/2025. Surety Bond (Tokio Marine/American Contractors Indemnity Company)is in effect with bond amount of $3,000.00 with expiration of 10/30/2025. The fire clearance is approved on 2/05/2014 for one (1) bedridden room. Fire drill was last conducted on 7/01/2024. The First Aid Kit is complete and current. Fire inspection completed on 11-03-2023. The facility was in compliance with Title 22 regulations. No immediate health and safety risks were observed during today’s visit. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, Sep 26, 2024

Allegation investigated: Facility is not adhering to their license

Licensing Program Analysts LPA Leizl de la Cerra conducted an unannounced visit for the above noted allegation. LPA met with Facility Administrator/Licensee, Rima Abelian and explained the reason for the visit. It was reported that bedridden resident (R1) is in room #2 but room #2 is not approved for fire clearance for a bedridden resident. To investigate this allegation on 7/02/2024, LPA requested copies of facility documents relevant to the investigation at 1:30pm, records included but not limited to residents’ and staff roster, R1’s facility file and etc. LPA de la Cerra conducted a facility tour between 2:00pm and 2:45pm. Requested files were reviewed between 2:45pm and 3:15pm. Staff interview was initiated between 3:15pm and 4:15pm. Continue to 9099-C... Substantiated A Review of R1’s physician report identified R1 as a bedridden resident. A review of facility approved Fire clearance completed on 02/05/2014,revealed that only room #3 is approved to retain bedridden resident. During facility inspection LPA de la Cerra observed bedridden resident R1 residing in the bedroom #2, which is not cleared bedridden fire clearance. Residents' roster also verified that R1 was residing in the bedroom #2. Furthermore, staff interview confirmed that R1 is bedridden resident receiving hospice care and acknowledged R1 is in a room that is not cleared to retain bedridden resident. Based on inspection, observation, interviews and record reviews, there is sufficient information to support the allegation. Therefore, allegation is substantiated at this time. Per CA Code of Regulations, Title 22 Division 6, Chapter 8, the following deficiency was cited and recorded on LIC9099-D. Non-compliance with fire clearance is posing immediate health and safety hazard to residents in care. Therefore, an immediate Civil penalty of $500.00 was assessed at the time of this visit. No other health and safety issues were observed at this time. Exit interview conducted. Appeal rights were discussed, and a copy of the report will be given to administrator.the state’s words, verbatim · CDSS document, Jul 2, 2024 · control 31-AS-20240626143208

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a)(2) · Plan of correction due date: Jul 3, 2024

87202(a)(2) All facilities shall maintain a fire clearance approved by fire dept... Prior to accepting any of the following types of persons, licensee shall obtain an appropriate fire clearance approved by fire dept, (2)Bedridden persons.This requirement is not met as evidenced by The Licensee failed to follow Title 22 Regulations regarding approved fire clearance, by placing bedridden resident R1 to the room that had no bedridden fire clearance. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jul 2, 2024

Plan of correction: Administrator stated that R1 will be transferred to the bedroom #3 by the end of the day. and within 24h will inform Licensing office in writing about R1’s relocation.