My Serenity Board and Care

Type of visit: Annual/Random

At 11:00 a.m. on 08/28/26, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection. LPA met with staff and later the licensee and disclosed the reason for the visit. LPA and the staff toured the facility inside and out. The facility was last visited on 03/10/26 for a complaint visit. It is a single story building with five (05) bedrooms, four (04) bathrooms, kitchen, common areas, and outdoor areas. It has an approved fire clearance for six (06) residents, of which five (05) may be nonambulatory and one (01) bedridden. The facility serves residents with dementia. Approved hospice waivers for six (06). At the main entrance, LPA observed postings for the facility’s visitation policy, staff and resident rosters, emergency disaster plan, facility sketch and license, personal rights, and blank copy of the admission agreement. Additional postings were observed inside for confidential complaint contacts, emergency contacts, rights of resident councils, and ombudsman contacts. A screening station at the front contained a visitor log. Walls, floors, windows, screens, and blinds were clean and in good repair. At 11:15 a.m. LPA measured the room temperature to be 75 degrees Fahrenheit. At 11:20 a.m., five (05) out of six (06) residents were observed conversing and watching television in the living room together. The living room contained a piano, musical equipment, reading material, art supplies, and exercise equipment. Two (02) hallway closets had board games, puzzles, and art supplies, PPE, and an adequate supply of fresh linens. Emergency lights were hung throughout the hallways. The facility has five (05) bedrooms. The bedroom nearest the main entrance is designated as a staff room. The staff room was locked. Of the four (04) resident bedrooms, two (02) are shared and two (02) are private. Bedroom #3 has a sign stating “No smoking – Oxygen in use”. Bedroom #3 and Bedroom #4 have private bathrooms. All bedrooms contained a chair, lamp, nightstand, storage, and a bed with adequate bedding. All furnishings were clean and in good condition. All hospital-style beds with wheels were in the locked position. The facility has four (04) bathrooms. All bathrooms contained liquid soap, paper towels, trash cans with a tight fitting lid, grab bars near the toilet and shower, and a non-skid mat in the shower. Commodes and shower chairs were also available. At approximately 11:35 a.m. LPA measured the water temperature in the shared bathroom to be 111.9 degrees Fahrenheit. LPA observed an adequate supply of perishable and non-perishable foods in the kitchen. Appliances were in good condition. Cleaning solutions were locked below the sink and in a separate cabinet near the staff room. Sharps were locked in a lock box in a drawer below the counter top. Medications were locked in a cabinet near the refrigerator. A washing machine and dryer were located outside of the kitchen. Both were in working order. Detergents were locked in a storage container next to the appliances. LPA observed two (02) covered, shaded patio areas in the rear and side of the facility. The patio contained furniture in good condition. Ramps were secure and had sturdy hand rails. Ramps led out from the living room and Bedroom #3. Two (02) out of two (02) emergency exit paths were free from tripping hazards. There was a locked storage shed with extra supplies. The pool was fenced, locked, and inaccessible. The exit gate was unlocked with a self-closing, inward facing latch. Evacuation routes were posted. Four (04) out of four (04) auditory alarms were turned on and functioning. At approximately 11:45 a.m., smoke and carbon monoxide detectors were tested and operational. When tested, the fire door in front of the main hallway closed automatically. At approximately 12:00 p.m. the house telephone was called and deemed to be operational. At 12:10 p.m. LPA observed a fully charged fire extinguisher in the kitchen. It was last inspected on 06/30/26 and had a tag attached. At 12:30 p.m. LPA reviewed resident and personnel files. Files were complete and available for audit. During today's inspection, the facility was in compliance with Title 22 regulations. No immediate health and safety risks were observed. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, Aug 28, 2026

Type of visit: Required - 1 Year

At 8:45 a.m. on 07/02/2025, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection. LPA met with staff and later the administrator and disclosed the reason for the visit. LPA and the adinistrator toured the facility inside and out. The facility was last visited on 06/14/24 for an annual visit. It is a single story building with five (05) bedrooms, four (04) bathrooms, kitchen, common areas, and outdoor areas. It has an approved fire clearance for six (06) residents, of which five (05) may be nonambulatory and one (01) bedridden. The facility serves residents with dementia. Approved hospice waivers for six (06). At the main entrance, LPA observed postings for the facility’s visitation policy, emergency disaster plan, facility sketch and license, personal rights, and blank copy of the admission agreement. Additional postings were observed inside for confidential complaint contacts, emergency contacts, rights of resident councils, and ombudsman contacts. A screening station at the front contained a visitor log. Walls, floors, windows, screens, and blinds were clean and in good repair. At 9:00 a.m. LPA measured the room temperature to be 75 degrees Fahrenheit. At approximately 9:25 a.m., smoke and carbon monoxide detectors were tested and operational. At approximately 9:30 a.m. the licensee called the house telephone, which was deemed to be operational. At 9:35 a.m. LPA observed a fully charged fire extinguisher in the kitchen. It was last inspected on 05/07/25 and had a tag attached. Five (05) out of five (05) residents were observed participating in activities in the living room together. Interview with the administrator at 9:45 a.m. today revealed the facility hired an activity coordinator who comes twice a week and a musician who comes once a week. The living room also contained a piano, musical equipment, reading material, art supplies, and exercise equipment. Hallway closets had board games, puzzles, and art supplies, PPE, and an adequate supply of fresh linens. Night lights were hung throughout the hallways. The facility had five (05) bedrooms. The bedroom nearest the main entrance is designated as a staff room. The staff room was locked and free of hazards. Of the four (04) resident bedrooms, two (02) are shared and two (02) are private. Bedroom #2 and Bedroom #4 had appropriate signs stating “No smoking – Oxygen in use”. Bedroom #3 and Bedroom #4 had private bathrooms. All bedrooms contained a chair, lamp, nightstand, storage, activity calnedars, call buttons, and a bed with adequate bedding. All furnishings were clean and in good condition. At approximately 10:00 a.m. the call button in Bedroom #1 was tested and deemed operational. The facility has four (04) bathrooms. Staff use the large bathroom nearest the main entrance to assist with bathing residents. All bathrooms contained liquid soap, paper towels, trash cans with a tight fitting lid, grab bars near the toilet and shower, and a non-skid mat in the shower. Commodes and shower chairs were also available. At approximately 10:15 a.m. LPA measured the water temperature to be within regulatory range. LPA observed an adequate supply of perishable and non-perishable foods in the kitchen. Appliances were in good condition. The administrator noted the microwave was promptly fixed after last year’s annual inspection. Cleaning solutions were locked below the sink and in a separate cabinet near the staff room. Sharps were locked in a lock box below the counter top. Medications were locked in a cabinet near the refrigerator. At approximately 10:30 a.m. a medication review was performed for three (03) residents. All medications were stored in the correct quantities. A washing machine and dryer were located outside of the kitchen. Both were in working order. Detergents were locked in a storage container next to the appliances. LPA observed a covered, shaded patio area in the rear of the facility. The patio contained furniture in good condition. Ramps were secure and had sturdy hand rails. Ramps led out from the living room and Bedroom #3. The emergency exit path was free from tripping hazards. There was a locked storage shed with gardening supplies. The pool was fenced, locked, and inaccessible. The exit gate was unlocked with a self-closing, inward facing latch. Evacuation routes were posted. Four (04) out of four (04) auditory alarms were turned on and functioning. At 10:45 a.m. LPA reviewed resident and personnel files. Files were complete and available for audit. During today's inspection, the facility was in compliance with Title 22 regulations. No immediate health and safety risks were observed. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, Jul 2, 2025

Type of visit: Required - 1 Year

At 9:00 a.m. on 06/14/2024, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection. LPA met with staff and later the administrator and disclosed the reason for the visit. LPA and staff toured the facility inside and out. The facility was last visited on 04/21/2022 for an annual visit. It is a single story building with five (05) bedrooms, four (04) bathrooms, kitchen, common areas, and outdoor areas. It has an approved fire clearance for six (06) residents, of which five (05) may be nonambulatory and one (01) bedridden. The facility serves residents with dementia. Approved hospice waivers for six (06). At the main entrance, LPA observed postings for the facility’s visitation policy, emergency disaster plan, facility sketch and license, and recent licensing report. Additional postings were observed inside for confidential complaint contacts, emergency contacts, and ombudsman contacts. Walls, floors, windows, screens, and blinds were clean and in good repair. At 9:15 a.m. LPA measured the room temperature to be 75 degrees Fahrenheit. At approximately 9:25 a.m., smoke and carbon monoxide detectors were tested and operational. At approximately 9:35 a.m. LPA observed a fully charged fire extinguisher in the kitchen. It was last inspected on 05/03/24. Five (05) out of six (06) residents were observed watching television in the living room together. The living room also contained a piano and exercise equipment. Closets had board games, puzzles, and art supplies. Night lights were hung throughout the hallways. The facility has five (05) bedrooms. The bedroom nearest the main entrance is designated as a staff room. The staff room was locked and free of hazards. Of the four (04) resident bedrooms, two (02) are shared and two (02) are private. Bedroom #2 had a bedridden resident with an unlocked, immediate exit with a clear pathway to exit. Bedroom #2 and Bedroom #4 had appropriate signs stating “No smoking – Oxygen in use”. Bedroom #3 and Bedroom #4 had private bathrooms. All bedrooms contained a chair, lamp, nightstand, storage, and a bed with adequate bedding. All furnishings were clean and in good condition. The facility has four (04) bathrooms. Staff use the large bathroom nearest the main entrance to assist with bathing residents. All bathrooms contained liquid soap, paper towels, trash cans with a tight fitting lid, grab bars near the toilet and shower, and a non-skid mat in the shower. At approximately 9:45 a.m. LPA measured the water temperature to be 114.5 degrees Fahrenheit. LPA observed an adequate supply of perishable and non-perishable foods in the kitchen. Appliances were in good condition, but a panel needed to be replaced above the microwave. This is addressed on an attached note of Technical Violation. Staff were observed preparing food and medication. Cleaning solutions were locked below the sink and in a separate cabinet near the staff room. Medications and sharps were locked above the counter and in a cabinet near the refrigerator. A washing machine and dryer were located outside of the kitchen. Both were in working order. Detergents were locked in a storage container. LPA observed a covered patio area in the rear of the facility. The patio contained furniture in good condition. A ramp with sturdy hand rails and free from tripping hazards led out from the living room and to the back yard. There was a locked storage shed with gardening supplies. The pool was fenced, locked, and inaccessible. All emergency exit paths were free from obstructions. The exit gate was unlocked with a self-closing, inward facing latch. Evacuation routes were posted. Auditory alarms were turned on and functioning. The house phone was called at 10:00 a.m. and deemed operational. At 10:15 a.m. LPA reviewed resident and personnel files. At 11:30 a.m. LPA conducted staff and resident interviews. During today's inspection, the facility was in compliance with Title 22 regulations. No immediate health and safety risks were observed. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, Jun 14, 2024