Serene Residential Care Home

Type of visit: Case Management - Incident

Licensing Program Analysts's (LPA) Melina Oropeza and Kesha Lewis arrived at this facility unannounced to conduct a case management incident that was receive on 03/16/2026. LPA's were met by staff and administrator joined 30 minutes later. LPA's explained the purpose of the visit to Administrator and staff. The incident report was received by the Department on 03/16/2026 regarding Resident 1 (R1) and Resident 2 (R2) having an altercation resulting in R2 being pushed out of their wheelchair and hitting their head. Based on interview with the administrator and observation of R1 and R2 the department is closing the investigation. The facility contacted all responsible parties and notified their physicians of R1 and R2 in accordance with Title 22 regulations. The facility has a plan moving forward about how to prevent another incident from occurring. LPA's offered some technique assistance regarding residents being sent for medical attention. No deficiency is being cited during this visit. Exit interview and copy of report was given.the state’s words, verbatim · CDSS document, Mar 24, 2026

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Kesha Lewis arrived at this facility unannounced to conduct a Required 1 Year Annual Inspection Visit. LPA was met by staff and administrator joined 10 minutes later. LPA explained the purpose of the visit to Administrator and staff. LPA and administrator inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry area, living area and other common areas, as well as outside of the facility to ensure compliance with Title 22 regulations. Facility is a 6 bed facility with a current census of 6. There is entry door is leading to the living room, kitchen with a hallway to the bedrooms and bathrooms. Chemicals and medications noted to be locked to residents in care. LPA also conducted the care tool. No bodies of water were observed at the facility. Hot water temperature was measured at 109 F degrees Fahrenheit in resident bathroom sink, which is within the required range of 105 to 120 degrees Fahrenheit. All necessary documents were in place. LPA observed the following posted on the facility wall: Facility license, sketch, See Something Say Something poster, Ombudsman poster, Theft and Loss Policy, Resident Bill of Rights, Rights of Resident/Family Councils. The facility submitted a LIC 808 mitigation plan, which was approved. The facility has central entry point. LPA observed the facility to have adequate food supply of 7 days non-perishables and 2 days perishables in place. Resident rooms were sanitary and had the required furniture and furnishings. LPA observed, fire extinguishers inspected on 07/14/2025 and current, smoke and carbon monoxide detectors, central heating and air in the facility. The first aid kit was found in compliance. LPA reviewed two (2) staff files. All staff is fingerprint cleared and associated to the facility and staff have current First Aid or CPR certifications on file. Facility is conducting initial and continuing training as required. LPA reviewed two (2) resident facility files, COVID-19 Plan, and survey binder. All necessary documents were in place. Exit interview held with staff and copies of reports left at conclusion of visit.the state’s words, verbatim · CDSS document, Nov 14, 2025

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Kesha Lewis and arrived unannounced to conduct a case management to follow up on an incident report that was received by the department on 11/02/2025. LPA met with administrator and explained the purpose of the visit. The incident report was regarding R1 ordering sharp objects and keeping them in their room. The facility will install a fingerprint lock on R1'S door to insure residents safety. Licensee ordered lock for the door while LPA was at the facility. Licensee will notify LPA Lewis on the outcome of the lock on the door. No further follow up is needed at this time. Exit interview and copy of the report given.the state’s words, verbatim · CDSS document, Nov 14, 2025

Type of visit: Case Management - Other

“Licensing Program Analyst (LPA) Kesha Lewis conducted a case management visit in order to follow up on Licensing Fees. Presently, the facility has an outstanding balance of $741.50. LPA met with staff and spoke with licensee over the phone. On 10/02/2024, Community Care Licensing Division (CCLD) sent a bill with the annual licensing fees to the Licensee; however, the annual fees have not been paid as of this date. LPA Lewis informed and explained to Licensee per (CCLD) regulations regarding Licensing Fees - The failure of an applicant or licensee to pay all applicable and accrued fees and civil penalties shall constitute grounds for denial or forfeiture of a license. In an effort to assist Licensee with a prompt payment, LPA provided the PIN number, which can be used to pay the balance immediately at CCLD website http://www.ccld.ca.gov/. No citation was issued on this day, however, the following advisory was given: please pay the Annual Licensing Fees to prevent further action. This is not a citation but an advisory. Administrator agreed to pay fees on or by 5/23/2025. An exit interview was conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, May 19, 2025

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Kesha Lewis arrived at this facility unannounced to conduct a Required 1 Year Annual Inspection Visit. LPA was met by staff. LPA explained the purpose of the visit to staff. LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry area, living area and other common areas, as well as outside of the facility to ensure compliance with Title 22 regulations. Facility is a 6 bed facility with a current census of 6. There is entry door is leading to the living room, kitchen with a hallway to the bedrooms and bathrooms. Chemicals and medications noted to be locked to residents in care. LPA also conducted the infection control domain tool. No bodies of water were observed at the facility. Hot water temperature was measured at 113 F degrees Fahrenheit in resident bathroom sink, which is within the required range of 105 to 120 degrees Fahrenheit. All necessary documents were in place. LPA observed the following posted on the facility wall: Facility license, sketch, See Something Say Something poster, Ombudsman poster, Theft and Loss Policy, Resident Bill of Rights, Rights of Resident/Family Councils. The facility submitted a LIC 808 mitigation plan, which was approved. The facility has central entry point. LPA observed the facility to have adequate food supply of 7 days non-perishables and 2 days perishables in place. Resident rooms were sanitary and had the required furniture and furnishings. LPA observed, fire extinguishers inspected on 07/08/2024 and current, smoke and carbon monoxide detectors, central heating and air in the facility. The first aid kit was found in compliance. LPA reviewed two (2) staff files. All staff is fingerprint cleared and associated to the facility and staff have current First Aid or CPR certifications on file. Facility is conducting initial and continuing training as required. LPA reviewed two (3) resident facility files, COVID-19 Plan, and survey binder. Citation is bing issued on todays visit. See 809D page... Exit interview held with staff and copies of reports given.the state’s words, verbatim · CDSS document, Nov 18, 2024

Type of visit: Case Management - Other

Licensing Program Analysts (LPA) Kesha Lewis arrived at the facility unannounced for the purpose of conducting a case management visit. LPA explained purpose of visit to the staff. The visit is following up on a complaint investigation In March of 2024. R1 paid for the month of March but was not present in the facility from the 21st of march on. The facility rented out the room R1 was occupying but also charged R1 for storage fees. An initial refund was given for $888.00. This amount is found to be incorrect. Storage fees are to be assessed because the facility room is unable to house another resident, but in this case a resident was able to occupy them room. Therefore a total refund of $1,770 is due witch is a prorated amount based on monthly rent divided by 30 days in a month. Another resident moved into the facility into R1'S room on 3/21/2024. $882.00 is still due. On 7/24/24 licensee sent remaining refund to R1'S responsible party. An exit interview was conducted and a copy of this report was given.the state’s words, verbatim · CDSS document, Jul 22, 2024

Allegation investigated: Staff denied resident and residents responsible party entry to facility. Staff did not follow terms of admissions agreement for resident in care. Staff did not ensure residents personal property was returned to resident.

Licensing Program Analyst (LPA) Kesha Lewis arrived at the facility unannounced deliver findings for the allegations listed above. LPA was greeted by staff and explained the reason for the visit. LPA also spoke with licensee on the phone. Allegations: Staff denied resident and residents responsible party entry to facility, staff did not follow terms of admissions agreement for resident in care, staff did not ensure residents personal property was returned to resident. After reviewing documentation and videos along with interviews with staff regarding the allegation LPA Lewis finds the complaint to be unsubstantiated. The facility was able to provide detailed information and show videos and provide proof of a refund being issued. Therefore, this complaint is UNSUBSTANTIATED. A finding that a complaint 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 did or did not occur, therefore the allegation is unsubstantiated. Exit interview conducted. copy of report given. Unsubstantiatedthe state’s words, verbatim · CDSS document, May 24, 2024 · control 27-AS-20240501121839

Type of visit: Case Management - Incident

Licensing Program Analysts (LPA) Kesha Lewis arrived at the facility unannounced for the purpose of conducting a case management visit regarding an incident where a resident hit a staff member and another residents visiting family. LPA Lewis talked with staff present and the licensee on the phone. The facility is taking steps to control R1's behavior. The licensee will email R1'S new care plan to LPA by 5/27/2024 COB. Per California Code of Regulations, Title 22 no deficiencies were observed or cited during today's case management inspection. An exit interview was conducted and a copy of this report was given.the state’s words, verbatim · CDSS document, May 24, 2024

Type of visit: Case Management - Other

Licensing Program Analysts (LPA) Kesha Lewis arrived at the facility unannounced for the purpose of conducting a case management visit following up LPA Ruth Wallace's visit on 11/13/2023. During LPA Wallace's visit there was a staff member that had not been finger printed. LPA explained purpose of visit to the staff. LPA Lewis talked with staff present and checked LIS and guardian to verify the staff was finger printed and associated to the facility. There were two (2) staff members present and one (1) staff member not present. All staff were verified to be fingerprinted and associated to the facility. Per California Code of Regulations, Title 22 no deficiencies were observed or cited during today's case management inspection. An exit interview was conducted and a copy of this report was given.the state’s words, verbatim · CDSS document, Jan 26, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ruth Wallace conducted required annual inspection visit. LPA met with licensee to explain purpose of visit. Administrator certificate number #6064223740 expires 10/06/2024. LPA and licensee toured and inspected the physical plant inside and outside to ensure there are no health and safety concerns. LPA observed the kitchen area, dining area, bedrooms, bathrooms, storage areas, garage, and laundry room. LPA observed knives/sharps, medications, and records storage to be locked. LPA observed required furniture, and lighting throughout the facility. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at 109.7 degrees Fahrenheit in resident bathroom sink, which is within the required range of 105 to 120 degrees. Fire extinguishers were last inspected on 6/3/2023. Smoke detectors are current and in compliance with fire safety. LPA observed centrally stored medications and toxins are kept locked and inaccessible to residents. LPA reviewed and compared resident medication vs. resident medication logs. LPA reviewed two resident and two staff files, including criminal record clearances. All staff are fingerprint cleared and associated to the facility. First aid kit was checked and is complete. Fire drill was conducted on 10/31/2023. LPA received the following updated document on today's date: LIC 308 - Designation of Administrator, copy of administrator's certificate, and copy of liability insurance. Per the California Code of Regulations, Title 22 no deficiencies were observed or cited. Exit interview held with licensee. A report and LIC 811 (Confidential Names) was left at the facilitythe state’s words, verbatim · CDSS document, Nov 13, 2023