Serenity Care Manor

Allegation investigated: Residents in care sustained falls due to neglect/lack of supervision.

At approximately 09:30 AM, Licensing Program Analyst (LPA) Ali Deniz arrived unannounced to deliver findings for a complaint investigation regarding the above allegation and met with Licensee/Administrator, Emmanuel Salas. During the course of the investigation, the Department conducted interviews, reviewed documents, and made observations. The following allegations were investigated: “Residents in care sustained falls due to neglect/lack of supervision”. The complaint alleged that Resident 1 (R1) experienced multiple falls while in care, resulting in bruising to the back, buttocks, neck, and under the left eye. Additional concerns were reported regarding R1’s safety and supervision needs due to R1’s history of falls, gait instability, and lack of coordination. Interviews conducted during the investigation revealed that R1 is prescribed blood thinner medication and bruises easily. R1’s family member acknowledged awareness of R1’s medical condition and confirmed that R1 is considered an extreme fall risk due to impaired gait and coordination difficulties. Continued on LIC9099-C page... Unsubstantiated Continued from LIC90999 page... The complainant further reported that R1 does not exhibit aggressive behaviors. Per staff interviews, R1 exhibits behaviors that contribute to bruising due to poor coordination and mobility challenges. Staff further stated that when an increase in falls was observed, the facility contacted R1’s physician to address R1’s changing care needs and obtain further medical guidance. LPA reviewed facility records and physician documentation provided by the facility. Records indicated that R1 has thrombocytopenia, a platelet insufficiency condition that may contribute to increased bruising and bleeding, and a history of transfusions related to this condition. Although R1 experienced bruising and has a documented history of falls, interviews conducted, and records reviewed did not provide sufficient evidence to support that the falls occurred as a result of neglect or lack of supervision by facility staff. Information obtained during the investigation indicated that R1’s medical conditions, use of blood thinners, impaired coordination, and thrombocytopenia likely contributed to the bruising observed. Based on interviews conducted, observations made, and records reviewed, there was insufficient evidence to determine that facility staff neglected R1 or failed to provide appropriate supervision. Therefore, the allegation is Unsubstantiated. A finding that the complaint allegation is UNSUBSTANTIATED means that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Exit interview conducted. Copy of report discussed and provided to Licensee/Administrator. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, May 12, 2026 · control 21-AS-20260209111257

Type of visit: Required - 1 Year

On 05/12/2026 at approximately 09:30AM, Licensing Program Analyst (LPA) Ali Deniz arrived unannounced to conduct 1-Year Required visit of this licensed Residential Care Facility for The Elderly (RCFE). LPA was greeted by Staff, Christian Morales Cervantes. Licensee/Administrator, Emmanuel Salas arrived during visit at approximately 10:05AM. Facility has an approved fire clearance and capacity for six (6) non-ambulatory residents and has an approved hospice waiver for two (2) residents. Upon arrival, LPA was informed that there were five (5) residents in care and two (2) staff member on-site. Facility is a single-story building with four (4) resident bedrooms, one (1) staff bedroom, two (2) bathrooms, and common spaces. At approximately 10:35AM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 10:45AM, LPA and Licensee toured the building and grounds which was found to be clean and in good repair. LPA observed all walkways and exits to be unobstructed. All notices that are required to be posted have been posted. The garbage bins in the resident room did not have proper cover or lid. Licensee agrees to get lid or cover for the garbage bins in the resident room (Technical Violation Given). Licensee agrees to submit proof of correction to CCL within ten (10) days of this visit. LPA observed activity supplies for resident use. The amount of fresh and nonperishable foods is not within the regulation. Licensee stated that today was the shopping day for the facility (Technical Advice Given). Facility kitchen, refrigerators and freezers were clean, and food was stored properly. Toxins are stored in a locked in the laundry room. Water temperature measured 118.6 degrees F which is within regulation between 105- and 120-degrees F at faucets accessible to residents. Fire extinguishers were bought new on 05/20/2025. Carbon Monoxide detectors were present and in order. There was enough lighting in all common areas, resident rooms, and hallways. Medication is centrally stored and secure. Continued on LIC809C... Continued from LIC809... At approximately 11:40AM, LPA reviewed four (4) resident records and found four (4) out of four (4) residents did have current physician's reports, care plans, signed admission agreements, and physician's orders on file. Medication records are thorough and contained physician's orders for each resident. LPA also reviewed three (3) staff records. 3 of 3 records did not have completed training records as required (See LIC-809 page). Evidence of first aid and CPR training were current. At approximately 12:30PM, LPA reviewed the facility emergency disaster plan with Licensee. The plan outlines evacuation routes, which are shown on facility sketch and has alternative meeting locations. Facility has supplies enough to operate for more than 72 hours in an emergency. Facility conducted and documented a disaster drill on 10/08/2027. Administrator Certificate is for Emmanuel Salas #7010884740 expires on 10/08/2027. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 10 days of this visit: LIC 308 Designation of Facility Responsibilities LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan (Last Page) LIC 9020 Register of Facility Resident’s Copy of Updated Certificate of Liability Insurance Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, LIC-809D, Plan of Corrections, and Appeal Rights discussed and provided to Administrator. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, May 12, 2026

The state marks this report as 6 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 05/30/2025 at approximately 09:30AM, Licensing Program Analyst (LPA) Ali Deniz arrived unannounced to conduct 1-Year Required visit of this licensed Residential Care Facility for The Elderly (RCFE). LPA was greeted by Staff, Christian Morales Cervantes. Licensee/Administrator, Emmanuel Salas arrived during visit at approximately 09:50AM. Facility has an approved fire clearance and capacity for 6 non-ambulatory residents and has an approved hospice waiver for 2 individuals. Upon arrival, LPA was informed that there were 5 residents in care and 1 staff member on-site. Facility is a 1 story building with 4 Resident bedrooms, 1 staff bedroom, 2 bathrooms, and common spaces. At approximately 10:05 AM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 10:15AM, LPA toured the building and grounds which was found to be clean and in good repair. LPA observed all walkways and exits to be unobstructed. All notices that are required to be posted have been posted. The garbage bins in the resident room did not have proper cover or lid. Licensee agrees to get lid or cover for the garbage bins in the resident room (Technical Advice given). LPA observed activity supplies for resident use. The amount of fresh and nonperishable foods is within regulation. Facility kitchen, refrigerators and freezers were clean, and food was stored properly. Toxins are stored in a locked kitchen cabinets under the sink and cabinets in the laundry room. Water temperature measured 109.6 degrees F and 107.4 which is within regulation between 105- and 120-degrees F at faucets accessible to residents. Fire extinguishers were bought new on 05/20/2025. Carbon Monoxide detectors were present and in order. There was enough lighting in all common areas, resident rooms, and hallways. Medication is centrally stored and secure. Continued on LIC809C... Continued from LIC809... At approximately 11:10AM, LPA reviewed 3 resident records and found 3 out of 3 residents did have current physician's reports, care plans, signed admission agreements, and physician's orders on file. Medication records are thorough and contained physician's orders for each resident. At approximately 12:05PM, LPA reviewed 3 staff records. 3 of 3 records did contain documentation of completed training records as required. Evidence of first aid and CPR training were current and/or renewed at the time of the visit. At approximately 12:50PM, LPA reviewed the facility emergency disaster plan with Licensee. The plan outlines evacuation routes, which are shown on facility sketch and has alternative meeting locations. Facility has supplies enough to operate for more than 72 hours in an emergency. Facility conducted and documented a disaster drill on 02/04/2025. Licensee/Administrator stated that they forgot to get it done and will complete on 05/31/2025(See LIC809D page). LPA was presented with proof of current CPR & 1st Aid certification for staff. Administrator Certificate is for Emmanuel Salas #7010884740 expires on 10/08/2025. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 10 days of this visit: LIC 308 Designated LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility Resident’s Copy of Updated Certificate of Liability Insurance Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, LIC-809D, Plan of Corrections, and Appeal Rights discussed and provided to Administrator. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, May 30, 2025

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 6/19/2024, Licensing Program Analyst (LPA) Tobola conducted an unannounced Annual Required – 1 yr. inspection for this facility and was greeted by Administrator, Emmanuel Salas. The facility currently provides care for 6 residents, none of which are receiving hospice services and some of which with a diagnosis of dementia. LPA continued with a tour of the facility with Administrator, facility found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguishers found to be purchased within the year and gauge is still within charged meter. Administrator will be purchasing new extinguishers in August 2024. Smoke and carbon monoxide detectors found throughout the facility, were tested and found to be functioning. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations, with food stored in the kitchen refrigerator found to have appropriate coverings. Staff provide residents with meals according to dietary restrictions with an ample amount of fresh and healthy foods observed. Cleaning supplies and other toxins are safely stored in locked cabinets in the laundry room, garage and under kitchen sinks, all of which were secured upon inspection. Sharps and other kitchen supplies that could pose danger if available to residents were found secured under kitchen cabinet. There was a supply of hygiene products and paper products available for residents. All resident’s bedrooms have lighting & appropriate furnishings and bedding items. Residents that were awake during the inspection were observed interacting with staff in the common area, outdoor patio and in their bedroom watching television or resting. The facility encourages regular family visits and utilizes outdoor areas for resident exercise and mobility. There are two emergency exits located in the backyard which were found to be unobstructed. There is an outdoor patio with shade and large outdoor space for residents to utilize with exits equipped with ramps for accessibility. Continued onto LIC809-C LPA conducted a sample file review for 3 residents and found needs & service plans and for two (2) residents in need of updating. In addition, LPA found that one (1) Physician's reports for resident with dementia is not in facility file. However, Administrator confirmed that the medical assessment was conducted in April 2024 and will be requesting the updated copy from the resident's family and placed on facility file. Technical Violations issued. Upon a spot check of medications, LPA found that two prescribed medications were not administered for resident due to resident leaving for day program before medications were given. Lastly, upon LPA observation and review of CCLD Guardian Background Check, LPA found that staff (I1) was not granted fingerprint clearance but observed working in the facility with residents in care. I1 was immediately removed from the facility and Administrator agrees to follow upon clearances and proper association guidelines. LPA requested the following documents be sent to CCL by COB 6/26/2024: LIC 308 Designated Facility Responsibility LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility Client’s/Resident’s Liability Insurance Control of Property/Rental Agreement Civil penalty issued under Title 22 Regulation 87355(d)(3) for a total of $100 due to staff not fingerprint cleared. Deficiency cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties.the state’s words, verbatim · CDSS document, Jun 19, 2024