La Serena House

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Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Hood arrived at the care home unannounced on June 30, 2026 to conduct a Required-1 Year Inspection utilizing the inspection tool. LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. LPA reviewed six (6) resident files and two (2) staff files. LPA also reviewed two (2) residents' medications and observed medication to be locked and inaccessible to residents in care. Facility has a current copy of certificate of liability insurance and LPA requested a copy. LPA also requested an updated staff roster and copy of emergency disaster plan. As a result of today's visit, no deficiencies were cited per California Code of Regulations, Title 22. LPA will return at a later time to finish touring the premises, conduct interviews, and complete annual inspection. Exit interview conducted and copy of report given at the conclusion of this visit.the state’s words, verbatim · CDSS document, Jun 30, 2026

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Michael Hood arrived at the facility unannounced on 7/24/25 to conduct an annual continuation visit utilizing the inspection tool following the Required-1 Year Inspection conducted on 7/23/2025. LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. LPA observed the backyard and perimeter of the care home to be free of clutter and debris. LPA observed smoke detectors and carbon monoxide detectors to be operational in the care home. LPA conducted interviews during inspection. LPA reviewed two (2) residents' medications and found medication to be locked away and inaccessible to the residents. As a result of today's visit, no deficiencies were cited per California Code of Regulations, Title 22. Exit interview conducted and copy of report given at the conclusion of this visit.the state’s words, verbatim · CDSS document, Jul 24, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Hood arrived at the facility unannounced on 7/23/25 to conduct a Required-1 Year Inspection utilizing the inspection tool. LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are four (4) bedrooms and two (2) bathrooms for resident use. LPA observed bedrooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition and properly maintained. Hot water temperature was observed to be 118 degrees F. LPA checked the kitchen area for the ability to prepare and store food. Care home has required two (2) day perishable and seven (7) day non-perishable food supply on cite. LPA observed knives, cleaning products, and other toxins to be locked away and inaccessible to residents. LPA reviewed six (6) resident files and three (3) staff files. Facility has a current copy of certificate of liability insurance and LPA requested a copy. As a result of today's visit, no deficiencies were cited per California Code of Regulations, Title 22. LPA will return at a later time to finish interviews, review medications, and complete annual inspection. Exit interview conducted and copy of report given at the conclusion of this visit.the state’s words, verbatim · CDSS document, Jul 23, 2025

Allegation investigated: Facility staff mismanaged resident's medications

On June 25, 2025 (6/25/24), Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility and met with Licensee, Aida Briones, to open an investigation into the complaint allegation listed above. During the investigation, the Department reviewed documentation pertinent to the investigation (CSMR and MARs) and received statements from additional parties involved in the R1’s care services. The results of the investigation are as follows: LPA Michael Hood received Centrally Stored Medication Form (CSMF) and Mediation Administration Record (MAR) for resident (R1). LPA reviewed R1’s CSMF and MAR and observed discrepancies between records for at least five (5) of R1’s medications. LPAs also reviewed a statement from hospice stating R1’s medications have not been managed and administered as ordered. Based on records reviewed, the preponderance of evidence standards have been met. Therefore, the above allegation is found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D page. Exit interview was conducted. A copy of this report and appeal rights were provided. Substantiatedthe state’s words, verbatim · CDSS document, Jun 25, 2025 · control 59-AS-20250620094344

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Jun 26, 2025

Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility (...) by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on records reviewed and statement, the facility did not ensure that resident R1 was receiving medications as prescribed, which poses an immediate health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jun 25, 2025

Plan of correction: Facility will complete a statement of understanding regarding regulation 87465 as well as the procedure for intake, recording and auditing medication records. Facility will submit statement to the Department by POC due date of 6/26/25.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Licensee, Aida Briones, to follow-up regarding documents received during a separate inspection conducted on December 11, 2024. During visit, LPA reviewed resident (R1's) documents on file at the facility. LPA observed that Physician's Report LIC 602A on file for R1 did not belong to R1 but to another individual. LPA requested a copy of R1's LIC 602A on file. Facility was unable to provide an LIC 602A for R1 on file by the conclusion of LPA's visit. LPA obtained a signature from Licensee regarding an amended report for inspection conducted on December 11, 2024. As a result of today's inspection, a deficiency is being cited pursuant to California Code of Regulations, Title 22, Division 6, Chapter 8. Deficiency is listed on 809-D pages. Exit interview was conducted. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Apr 15, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87458(a) · Plan of correction due date: Apr 30, 2025

87458 Medical Assessment (a) Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment, signed by a licensed medical professional acting within the scope of their practice and made within the last year, to be kept in the resident's record. This requirement is not met as evidenced by: Based on records reviewed, the facility did not ensure to obtain a medical assessent made within the last year prior to admission for resident (R1), which poses a potential health, safety, and personal rights risk to the residents in care.the state’s words, verbatim · CDSS document, Apr 15, 2025

Plan of correction: Facility will write a statement of understanding regarding regulation 87458 and submit statement to LPA by POC due date of 4/30/2025.

Allegation investigated: Staff handled resident in a rough manner. Staff is not treating residents with dignity. Staff broke resident’s wheelchair. Staff sleep while on duty.

Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Licensee, Aida Briones, to deliver findings into the complaint allegations listed above. During the investigation, the Department conducted interviews, toured the facility, and reviewed documentation pertinent to the investigation. The results of the investigation are as follows: ** Report continued on 9099-C ** Unsubstantiated A relevant party reported to the Department that staff member (S1) handled resident (R1) in a rough manner, was not treating R1 with dignity, and broke R1's wheelchair. Interview with relevant party indicated that they did not personally witness these allegations but was told about the allegations after speaking with R1. Relevant party also stated that S1 was witnessed to appear as if they had just woke up before answering the front door. Relevant party stated that they did not personally witness the incident in which S1 answered the front door. Interview with R1 confirmed the allegations addressed in the complaint regarding S1. However, R1 stated that S1 slept at night when the other residents were asleep. Interviews conducted with residents (R2 and R3) indicated that the knew both R1 and S1 and stated that they never witnessed any of the allegations addressed in the complaint or experience any of the allegations addressed in the complaint. R3 stated that they thought S1 did a good job at the facility and did "above and beyond" in regards to providing care to the residents. Interviews conducted with staff members (S2 and S3) and Licensee indicated that they never witnessed any of the allegations addressed in the complaint. S2 stated that they knew both R1 and S1. S2 stated that S1 taught them a lot about the residents and S2 never witnessed anything offensive to make S2 question S1 as a caregiver. Interviews conducted with residents R2, R3, R4, and R5 indicated that they feel they are treated well by facility staff and their care needs are being met at the facility. R1's Admission Agreement indicates that R1 was admitted to the facility on 3/16/2024. R1's hospice records indicate that R1 was admitted to hospice services on 3/16/2024. A review of R1's hospice records did not indicate any additional witnesses regarding allegations addressed in complaint. Interview with representative from R1's hospice agency indicated that they did not witness the allegations addressed in the complaint. Hospice records indicate education was provided to S1 regarding transfer assistance to R1. Hospice records indicate R1's sustained an unwitnessed fall on 4/23/2024, in which paramedics assisted R1 back into their wheelchair with no injuries reported. ** Report continued on 9099-C ** Based on interviews conducted and records reviewed, the preponderance of evidence standards have not been met. Therefore, the above allegation is found to be UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview was conducted with Licensee. A copy of this report was provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Dec 11, 2024 · control 59-AS-20240515123429

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Licensee, Aida Briones, to follow-up regarding concerns brought up during a separate inspection conducted on 12/11/2024. During visit, LPA conducted an interview with Licensee. LPA will conduct a follow-up visit if deemed necessary. No deficiencies are being cited as a result of today's visit. Exit interview was conducted with Licensee. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Dec 11, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Hood arrived at the facility unannounced on 5/22/24 to conduct a Required-1 Year Inspection utilizing the inspection tool. LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are four (4) bedrooms and two (2) bathrooms for resident use. LPA observed bedrooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition and properly maintained. Hot water temperature was observed to be 113.2 degrees F. LPA checked the kitchen area for the ability to prepare and store food. Care home has required two (2) day perishable and seven (7) day non-perishable food supply on cite. LPA observed knives, cleaning products, and other toxins to be locked away and inaccessible to residents. LPA observed the backyard and perimeter of the care home to be free of clutter and debris. LPA observed smoke detectors and carbon monoxide detectors to be operational in the care home. First aid kit is maintained and ready for emergency use. LPA checked medication storage and found medication to be locked away and inaccessible to the residents. LPA reviewed three (3) resident files and three (3) staff files. Facility has a current copy of certificate of liability insurance and LPA requested a copy. As a result of today's visit, no deficiencies were cited per California Code of Regulations, Title 22. Exit interview was conducted and copy of the report was given to the care home at the conclusion of today's visit.the state’s words, verbatim · CDSS document, May 22, 2024