My Serenity Senior Home

Type of visit: Annual/Random

At 1:30 p.m. on 08/28/26 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection. LPA met with the administrator and disclosed the reason for the visit. LPA and administrator toured the facility inside and out. The facility was last visited on 07/02/25 for an annual inspection. It is a single story building with five (05) bedrooms, two (02) bathrooms, kitchen, common areas, and outdoor areas. It has an approved fire clearance for six (06) nonambulatory residents, of which one (01) may be bedridden in Bedroom #5. The facility serves residents with dementia. Approved hospice waivers for six (06). The front yard was maintained and contained fruit-bearing trees. At the main entrance, LPA observed postings for confidential complaint contacts, ombudsman contacts, emergency contacts, facility license and sketch, personal rights, emergency disaster plan, a blank copy of the admission agreement, a recent licensing report, and visitation policy. The screening station contained a visitor log and hand sanitizer. Walls, floors, windows, screens, and blinds were clean and in good repair. The living room contained a television, furniture in good repair, decorations, musical equipment, reading materials, and a piano. Emergency lights were hung in hallways. A linen closet contained an adequate supply of fresh linens. At 1:35 p.m. LPA measured the room temperature to be 75 degrees Fahrenheit. The facility has five (05) bedrooms. Bedroom #5 is designated as a staff room. The staff room was locked and free of hazards. Bedroom #2 and Bedroom #3 are shared rooms. Bedroom #1 and Bedroom #4 are private rooms. All bedrooms contained a chair, lamp, nightstand, call button, storage, and a bed with adequate bedding. All furnishings were clean and in good condition. Ramps leading out from Bedroom #2 and Bedroom #5 were free of tripping hazards and had sturdy handrails. At 1:45 p.m. the smoke and carbon monoxide detectors were tested and deemed operational. At approximately 1:55 p.m. the house telephone was called and deemed operational. At 2:00 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. LPA observed two (02) covered patio areas in the rear of the facility. The patio contained furniture in good condition and exercise equipment. The storage shed was locked and contained tools and supplies. The rear gate was unlocked. The facility had two (02) bathrooms. All bathrooms contained liquid soap, paper towels, trash can with a tight fitting lid, grab bars near the toilet and shower, and a non-skid surface in the shower. At approximately 2:15 p.m. LPA measured the water temperature in the front shared bathroom to be 109.6 degrees Fahrenheit. LPA observed an adequate supply of perishable and non-perishable foods in the kitchen. The stove hood was clean. Appliances were in good condition. Sharps were locked below the sink in a lock box. Cleaning solutions and detergents were locked above the washer and dryer. Medications were locked in a cabinet in the kitchen. A washing machine and dryer were located adjacent to the kitchen. Both were in working order. The emergency exit path was free from obstructions. Exit gates were unlocked with self-closing latches. Evacuation routes were posted. Five (05) out of five (05) auditory alarms were turned on and functioning. At 4:15 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 11:55 a.m. on 07/02/25, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection. LPA met with the administrator and disclosed the reason for the visit. LPA and administrator toured the facility inside and out. The facility was last visited on 06/14/24 for an annual inspection. It is a single story building with five (05) bedrooms, two (02) bathrooms, kitchen, common areas, and outdoor areas. It has an approved fire clearance for six (06) nonambulatory residents, of which one (01) may be bedridden in Bedroom #5. The facility serves residents with dementia. Approved hospice waivers for six (06). The front yard was maintained and contained fruit-bearing trees. At the main entrance, LPA observed postings for confidential complaint contacts, ombudsman contacts, emergency contacts, facility license and sketch, personal rights, emergency disaster plan, a blank copy of the admission agreement, and visitation policy. The screening station contained a visitor log and hand sanitizer. Walls, floors, windows, screens, and blinds were clean and in good repair. LPA observed the activity coordinator hanging decorations and engaging activities with residents. The living room contained television, furniture in good repair, decorations, musical equipment, reading materials, and a piano. Night lights were hung in hallways. A linen closet contained an adequate supply of fresh linens. At 12:05 p.m. LPA measured the room temperature to be 76 degrees Fahrenheit. The facility had five (05) bedrooms. Bedroom #3 is designated as a staff room. The staff room was locked and free of hazards. Bedroom #1 and Bedroom #2 are shared rooms. Bedroom #4 and Bedroom #5 are private rooms. All bedrooms contained a chair, lamp, nightstand, call button, storage, and a bed with adequate bedding. All furnishings were clean and in good condition. Ramps leading out from Bedroom #2 and Bedroom #5 were free of tripping hazards and had sturdy handrails. At approximately 12:50 p.m. the house telephone was called and deemed operational. At 1:00 p.m. the smoke and carbon monoxide detectors were tested and deemed operational. At 1:05 p.m. LPA observed a fully charged fire extinguisher in the kitchen. It was last inspected on 05/07/25 and had a tag attached. LPA observed two (02) covered patio areas in the rear of the facility. The patio contained furniture in good condition and exercise equipment. The storage shed was locked and contained tools and supplies. The rear gate was unlocked. The facility had two (02) bathrooms. All bathrooms contained liquid soap, paper towels, trash can with a tight fitting lid, grab bars near the toilet and shower, and a non-skid surface in the shower. At approximately 1:30 p.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. The stove hood was clean. Appliances were in good condition. Sharps were locked below the sink in a lock box. Cleaning solutions and detergents were locked above the washer and dryer. Medications were locked in a cabinet in the kitchen. A medication review was conducted at approximately 1:35 p.m. All medications were present in the correct quantities. A washing machine and dryer were located adjacent to the kitchen. Both were in working order. At approximately 1:40 p.m. LPA observed a fully charged fire extinguisher in the kitchen. It was last inspected on 05/03/24. All emergency exit paths were free from obstructions. Exit gates were unlocked with self-closing latches. Evacuation routes were posted. Five (05) out of five (05) auditory alarms were turned on and functioning. At 1:45 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, Jul 2, 2025

Type of visit: Required - 1 Year

At 1:20 p.m. on 06/14/2024, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection. LPA met with the administrator and disclosed the reason for the visit. LPA and administrator toured the facility inside and out. The facility was last visited on 04/21/2022 for an annual inspection. It is a single story building with five (05) bedrooms, two (02) bathrooms, kitchen, common areas, and outdoor areas. It has an approved fire clearance for six (06) nonambulatory residents, of which one (01) may be bedridden in Bedroom #5. The facility serves residents with dementia. Approved hospice waivers for six (06). LPA observed an adequate supply of perishable and non-perishable foods in the kitchen. The stove hood was clean. Appliances were in good condition. Sharps were locked below the sink. Cleaning solutions and detergents were locked above the washer and dryer. Medications were locked in a cabinet in the kitchen. A washing machine and dryer were located adjacent to the kitchen. Both were in working order. At approximately 1:40 p.m. LPA observed a fully charged fire extinguisher in the kitchen. It was last inspected on 05/03/24. At the main entrance, LPA observed postings for confidential complaint contacts, ombudsman contacts, emergency contacts, facility license and sketch, personal rights, emergency disaster plan, and visitation policy. A visitor log recorded guests and screened for infectious disease. Walls, floors, windows, screens, and blinds were clean and in good repair. An activity calendar was posted near the kitchen. Around 1:50 pm. the administrator informed the LPA that an Activity Director manages and schedules activities, and a physical activity assistant comes to the facility twice per week to assist with resident fitness. At approximately 2:00 p.m. smoke and carbon monoxide detectors were tested and operational. At 2:05 p.m. LPA measured the room temperature to be 77 degrees Fahrenheit. The living room contained television, seating, decorations, and a piano. At approximately 2:20 p.m. the house telephone was called and deemed operational. Nightlights were located throughout the hallways, A linen closet located between bedroom #5 and bedroom #4 had an adequate supply of fresh linens. LPA observed a covered patio area in the rear of the facility. The patio contained furniture in good condition and exercise equipment. An additional couch was located under a covered awning. A storage shed was locked. The facility has five (05) bedrooms. Bedroom #3 is designated as a staff room. The staff room was unlocked and free of hazards. Bedroom #1 and bedroom #2 are shared rooms. Bedroom #4 and Bedroom #5 are private rooms. All bedrooms contained a chair, lamp, nightstand, storage, and a bed with adequate bedding. All furnishings were clean and in good condition. All bedrooms had immediate exits to the outside which were unlocked. Ramps leading out from bedroom #2 and bedroom #5 were free of tripping hazards and had sturdy handrails. The facility has 2 bathrooms. 1 bathroom is private, and 1 is shared. All bathrooms contained liquid soap, paper towels, trash can with a tight fitting lid, grab bars near the toilet and shower, and a non-skid surface in the shower. At approximately 2:30 p.m. LPA measured the water temperature to be 107.7 degrees Fahrenheit. All emergency exit paths were free from obstructions. Exit gates were unlocked with self-closing latches. Evacuation routes were posted. All auditory alarms were turned on and functioning. At 2:30 p.m. LPA reviewed resident and personnel files. At 3:15 p.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