Buck Serenity Homes

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Contreras arrived unannounced to conduct a required annual inspection and was greeted by administrator(admin) Gideon Castro. Facility is an Adult Residential Care for the Elderly licensed for a capacity of 6 residents. There are currently 5 residents in care. Facility is a two story facility, residents reside in first floor and staff rooms are located in second floor of facility. LPA toured the building and grounds which was found to be at a comfortable temperature. LPA observed at least a 2- day supply of perishable and 7- day supply of non-perishable food. Expiration dates were not noted in some food items in refrigerator (Technical Violation given). Resident bathroom had required bath mat and grab bar. Bathroom found with paper towels and toilet paper. Dryer and washer found operational. Toxins found in two resident bathrooms unlocked under bathroom sink including chemicals found unsecured in bathrooms accessible for residents(Deficiency cited, see 809D). Water temperature in sink accessible to residents in care measured within the allowable range of 105 to 120 degrees F. Resident bedroom observed to be equipped with lighting, night stand, and chest of drawer. LPA toured the outside backyard of facility and observed emergency exits free from obstruction. Noticeable spider webs and collected dust observed in resident window sills (Technical Violation given). Five out of five resident rooms did not have door signal system turned on in door that leads to outdoor perimeter of facility (Deficiency cited, see 809D). Fire extinguishers were last inspected 4/15/2025. Smoke/Carbon Monoxide detectors located throughout the facility are tested through Fire Marshall. Disaster drills conducted quarterly. LPA conducted file review for 5 out of 5 residents. LIC613 Personal Rights signature missing from one (R1) resident file (Technical Advisory given). Continued onto 809C..... continued from 809... LPA conducted file review for 3 staff. One staff (S1) missing LIC501 Job Application (Technical Advisory given) . LPA conducted medication spot check. Centrally stored log up was observed to not be complete with 9 medications not listed in Centrally Stored Medication Log for R2 (Deficiency cited, see 809D). Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC500- Personnel Report LIC308- Designation of Responsibility Liability Insurance Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given and discussed with Administrator. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with administrator.the state’s words, verbatim · CDSS document, Mar 5, 2026

Allegation investigated: Staff do not ensure resident's bathing needs are being met Staff admitted a resident who required a higher level of care

Licensing Program Analyst (LPA) Contreras arrived unannounced to deliver complaint findings regarding complaint #21-AS-20251103153410. LPA was greeted by administrator (admin) Gideon Castro. During the investigation, the Department requested and reviewed documents, conducted interviews and made observations. Complaint alleges staff admitted a resident who required a higher level of care and staff do not ensure resident's bathing needs are being met. Complainant states that resident (R1) was not showered by facility staff due to R1’s large size which requires a two-person assist. During the investigation, LPA reviewed R1’s Preplacement appraisal completed and signed by licensee on 9/24/25. Preplacement appraisal indicates that upon admission, the facility concluded that R1 needed help with bathing, hair care, and personal hygiene; moreover, it was assessed that R1 needed a two-person assist. The Preplacement appraisal also indicates that R1 needed a two-person assist when needing help with transferring in and out of bed and dressing. Continued onto 9099-C... Substantiated continued from 9099-A..... During investigation, LPA reviewed R1’s Preplacement appraisal which indicates that, upon admission, the facility concluded that R1 required a two-person assist. The Preplacement appraisal also indicates that R1 needed a two-person assist when needing help with transferring in and out of bed and dressing. Licensee advised LPA that additional reason for eviction was that he was sick of R1’s responsible party’s demands. LPA advised licensee of regulation 87224 which provides the conditions under which a resident can be lawfully evicted. Licensee did not issue a formal written eviction notice, only a text message indicating his frustration and desire to have R1 find another home. R1 subsequently left the facility. However, R1 was not removed from the facility by licensee, R1 left of their own accord. So, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Copy of report read and given to administrator continued from 9099.... During the investigation, licensee advised LPA that they “could not handle” R1’s care any longer because R1 had “too many changes of condition". Licensee advised LPA during preplacement it was determined that R1 was only a one person assist, according to facility’s assessment. However, licensee claims that R1 was now requiring a two-person assist which is a higher level of care than previously identified. During investigation, LPA reviewed R1’s Preplacement appraisal which indicates that, upon admission, the facility concluded that R1 required a two-person assist. The Preplacement Appraisal also indicates that R1 needed a two-person assist when needing help with transferring in and out of bed and dressing. LPA reviewed R1’s Admission Agreement, which lists the basic services provided by the facility will include, at a minimum, assistance with bathing. LPA requested proof of facility providing showers to R1 but facility could not produce a shower log or any documentation of facility providing showers. Additionally, during the investigation, LPA conducted interviews. Witness (W1) reported to LPA that facility staff refused to give R1 showers due to R1’s large size and having to use a Hoyer lift; instead, they would give R1 bed baths. W1 reported to LPA that the only showers R1 received were provided by non-facility staff. Therefore, based on LPA’s interviews and record review, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 Chapter 8, are being cited on the attached 9099-D. Copy of report read and given to administrator. Appeal rights given.the state’s words, verbatim · CDSS document, Jan 29, 2026 · control 21-AS-20251103153410

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.269(a)(6) · Plan of correction due date: Jan 29, 2026

§1569.269Enumerated rights(a) Residents of residential care facilities for the elderly shall have all of the following rights: (6) To care, supervision, and services that meet their individual needs...delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement has not been met as evidence by: Based on records review, observations and interviews conducted Licensee did not ensure to services needs were provided necessary to meet individual care needs which poses an immediate risk to the health and safety of residents in care.the state’s words, verbatim · CDSS document, Jan 29, 2026

Plan of correction: Facility to submit plan to register all staff to participate/attend the ombudsman training for personal rights. Facility to submit plan to contact the local ombudsman to facilitate personal rights training for all staff by plan of correction due date. Facility to get the date of the next personal rights training and provide the date to CCL by no later than 2/04/25. Once attendance/ participation is completed facility to submit training certificate or record showing all staff in attendance, hours of attendance, date of attendance, and instructor name. Training to be completed by 3/01/2026.

From the deficiency page — Deficiency type: Type A · Section cited: HSC 87464(f)(4) · Plan of correction due date: Jan 29, 2026

Basic Services 87464(f)(4) Personal assistance and care...as indicated in the pre admission appraisal, with those activities of daily living such as...bathing... This requirement is not met as evidenced by: Based on record review and interviews Staff refused to give R1 showers due to R1’s large size and facility was not able to provide documentation of shower logs.the state’s words, verbatim · CDSS document, Jan 29, 2026

Plan of correction: Licensee to submit self certification that staff will be trained on documenting all bathing needs and refusals for all residents as indicated in their admissions agreement .In addition licensee to submit weekly bathing logs for the following 3 weeks to CCLD Licensee to submit self certification to CCL by Plan of Correction due date of 1/30/2026

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Christi Coppo and Ethel Contreras arrived unannounced to conduct a required Annual inspection and was greeted by Administrator Gideon Castro. Facility contact information was reviewed. At approximately 10:00am LPA and Admin toured the building and grounds. The facility was found to be clean and at a comfortable temperature. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. Food was found to be stored in a safe manner with open items covered. Kitchen cabinet containing cleaning supplies was locked. Kitchen drawer with sharp knives locked. All bedrooms were equipped with lighting, night stand, and chest of drawers. All bedrooms were clean and in good repair. Extra hygiene products and linens were available. Resident bathroom did not have required bath mat(Technical). Restrooms did have required grab bar. Facility has two water heaters. Water temperature in sink accessible to residents in care measured at 116.6 degrees F which is within the allowable range of 105 to 120 degrees F. Restroom in room six water measured at 99.01 which is not within the allowable range of 105 to 120 degrees F. Bedroom five had oxygen tanks in which 1 out of 3 were not placed in holder and not strapped to the wall (Technical). LPAs observed Thick-It thickener stored under stairs made accessible to residents. Thickener prescribed to resident's name that does not match any current residents. Medication fridge unlocked, making medication accessible to residents. Fridge had suppositories (Bisacodyl 10mg) with resident's name that does not match any current residents. Insulin pen without a label inside ziplock bag in also in fridge. (Deficiency cited, see 809D). Medications found to be pre-poured in small plastic containers inside kitchen drawer on left hand side of refrigerator and not in its originally received container. (Deficiency cited, see 809D) Continued on 809C... Continued from 809... Tiles on vanity in bathroom next to room #4 and around left hand side of kitchen sink observed to have dark black substance present in grout as well as broken tile. Deck ramp on wrap around deck has two sections of plywood. Section of plywood in the middle of ramp bows heavily under pressure, cracking sound when stepped on. (Deficiency cited, see 809D). Fire extinguishers were last inspected 4/1/25. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Facility’s last quarterly disaster drills were conducted with each staff member during their respective training days, LPA observed all training dates for respective staff were within the quarter. Facility has a backup generator for use during a power outage. LPA conducted a review of 4 resident records. All required documentation present. 1/2 rails and crushed meds orders all on file for respective residents. LPA conducted review of 3 staff records. Health Screening for all staff appeared fabricated. Health Screenings had same exact hand writing and date of visits listed within 3 days of each other. Furthermore, signature of physician appeared to be he same on all screens and lacked date. Additionally, TB test marked as negative but action taken listed as chest X-ray. LPAs discussed appearance of fabrication with admin. Admin denies fabrication. Admin agrees to submit current health screenings with TB clearance to CCL. Three out of three staff had expired first aid expiring on 1/06/2025. Additionally, LPAs attempted verification of first aid certificate numbers via American Red Cross website, unable to locate certificate. (Deficiency cited, see 809D). Continued on 809C(2).... Continued on from 809-C... LPA and Admin conducted a spot check of medication and medication records. Medication is centrally stored in a locked closet. LPAs advised admin to complete prescribing physician;on Centrally Stored Medication Log. Gideon Castro Administrator Certificate #7004971740 expires 5/19/2026. All fees are current as of this time. LPA and Administrator discussed facility's Infection Control Plan and Emergency Disaster plan. No new updates. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC500- Personnel Report LIC308- Designation of Responsibility Liability Insurance Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given and discussed with Administrator. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with Administrator and a copy of this report was given. LPAs experienced printer issues and was unable to final print, time of completion 3:50pm. LPAs will email copy of report and deficencies.the state’s words, verbatim · CDSS document, Apr 29, 2025

The state marks this report as 9 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Gideon Castro, Administrator and Elena Castro, caregiver, and explained purpose of inspection. Also present were caregivers, Teodorico Santos and Gina Taganahan. LPA observed (1) resident to be visiting with a family member in the common area and (3) residents to be resting in their rooms. The facility is located away from the main street and is up on a hill with a view. There are no neighbors in close proximity. The facility is licensed for (6) non-ambulatory residents and has a hospice waiver for (3). Currently, there is (1) resident under hospice care. toured the interior and exterior of the facility including the common areas, (4) private resident bedrooms (6) private resident bedrooms, (4) resident bathrooms, kitchen, laundry area and (2) staff rooms on the second floor. LPA observed the facility to be clean, in good repair and odor-free. LPA observed the bathrooms to have the necessary grab bars, non-skid flooring, paper towels and hand-washing posters. There is sufficient 2+day perishable, including fresh produce, and 7+day non-perishable supply of food. Sharps, medications and toxins are locked in/near the kitchen. The inside temperature measured 76*F and the hot water measured 105*F in resident bathroom. The smoke/monoxide alarms are working and quarterly drills are conducted. There are sufficient linens/towels/blankets and paper supplies, including PPE. Each resident room has an exit to the backyard and there is main parking gate near the front entrance. There are no pools/ponds. LPA reviewed (2) of (4) resident files and found them to be organized and contain current physician's reports and appraisals. Medications were reviewed for (1) resident- orders matched medications administered and MAR documentation is current. LPA reviewed (5) of (9) staff files and found them to be complete and contain current training documentation, including for First Aid/CPR. RCFE Administrator Certificate #6016577740- exp 5/19/24- renewal has been initiated. All staff is cleared and associated. LPA requested an updated copy of the LIC308, LIC500 by 4/25/24. Copy of current liability insurance was obtained. There are no citations issued. Exit interview. Copy of report provided.the state’s words, verbatim · CDSS document, Apr 18, 2024