Serene Legacy

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Janira Arreola and Aziz Faizi conducted an unannounced annual required visit. LPA was granted entry and met with Administrator, Monica Ortiz, who was informed of the purpose of the visit. At the time of the visit there was (2) staff and (2) residents present. The facility is a one story home with (4) resident bedrooms and (2) bathrooms. No pools or firearms are housed at the facility. The facility is approved for (6) non ambulatory residents. Physical plant, floors, windows, and doors were observed to be clean. Fixtures and furniture were in good repair were present. The outdoor area and passage ways were observed to be free of hazards. LPA observed hygiene supplies for residents, PPE, clean linens. There are designated locked areas for sharps, dangerous objects, cleaning supplies, and medications. During the visit LPAs observed unlocked cleaning supplies and gardening tools in the back yard and unsecured knife in the kitchen. A deficiency was documented and plan of correction was created. The smoke detector and carbon monoxide are operational, and the hot water temperature 118F. There are emergency supplies such as emergency lighting, complete first aide kit and emergency food and water. LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods. LPA reviewed the facility's emergency and disaster plan and infectious control plan. The facility has conducted a fire drill but did not document it, there a deficiency was cited and a plan of correction was created. Required postings were found in the facility. The listed administrator, possesses a current administrator's certificate. LPA reviewed (2) staff files and training. All staff have criminal clearance. (1) staff did not have updated CPR/First Aid Certification and did not have a health screening on file A deficiency was issued for completion of the staff's file. LPAs provided the licensee a copy of the LIC311F with all required forms to keep in resident and staff files. The Two (2) resident files were reviewed, and possessed all required paperwork. No resident's personal and incidental funds are being handled by the facility. LPA observed resident medications which are locked, filled, and stored in their originally received containers. The medication was accounted for on Centrally Stored Medication logs for residents. Technical Support services were offered and the licensee agreed to a referral for the program. An exit interview was conducted where this report was reviewed and provided.the state’s words, verbatim · CDSS document, Jan 29, 2026

Type of visit: Prelicensing

Licensing Program Anaylst (LPA) Janira Arreola conducted an announced Prelicensing Visit. LPA was granted entry by and met with, Applicant Monica Ortiz who was informed of the purpose of the visit. The applicant is seeking an initial license for a Residential Care Facility for the Elderly, for ages 60 and above. The facility is a (2) story home with resident rooms on the first floor totaling (3) bedrooms and (2) bathrooms. All (3) bedrooms have been approved by the local fire jurisdiction for (6) non-ambulatory residents. There are no bodies of water, weapons or fire arms kept at the facility. LPA observed the kitchen had cooking supplies and equipment in good working condition. The facility meets the (2) day perishable and (7) day non-perishable supply of food. The knifes and cleaning supplies will be kept locked in the laundry room. The medications will be kept in a locked cabinet in the kitchen. The outdoor area was observed to be free of hazards and has an emergency exit. There are activity supplies for future residents to engage in in the entry way. LPA observed the resident bedrooms had the required furniture and the bathrooms have grab bars and hygiene supplies for future residents. The hot water temperature was recorded at 118F and the carbon monoxide and smoke alarms are in working condition. The laundry room had cleaning supplies to do regular cleaning of the facility, and equipment in good working condition. There is a supply of linens and towels for future residents. The facility has areas designated for future staff and resident records. Required postings are found in the dinning room, and emergency and PPE supplies were kept in a hallway closet. The facility phone number is operational at (951) 627-5930. There are no objections for the applicant to proceed in the prelicensing process. An exit interview was conducted where this report was reviewed and provided to the applicant.the state’s words, verbatim · CDSS document, Jan 6, 2025

Type of visit: Office

Facility Type: Residential Care Facility for the Elderly Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: MONICA ORTIZ Interview Method: Telephone interview On December 03, 2024, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed the understanding of the California Code Title 22 Regulations. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restricted/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Dec 3, 2024