Serene Care Winchester

Type of visit: Required - 1 Year

On 2/5/2026 at 9:50am, Licensing Program Analyst (LPA) L. Hall conducted an unannounced annual required inspection. LPA met with Caregiver, Josephine Ambagan, and explained the purpose of the visit. Licensee, Jennifer Rances, arrived at 10:27am. Administrator holds a certificate #7033979740 expires 3/6/2026. The fire clearance is approved for two (2) ambulatory and four (4) non-ambulatory residents. LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of six (6) bedrooms and two (2) bathrooms. One (1) bedroom occupied by staff. No bodies of water observed. A comfortable temperature is maintained at 74 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 113.4 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods. Smoke detectors/ carbon monoxide were in operating condition during visit. Emergency disaster plan last reviewed 12/23/2025. Fire extinguisher was last purchased 12/27/2025. First aid kit was observed to be complete. Fire drill was last conducted on 01/09/2026. Continued on LIC809. Continued from LIC809. LPA reviewed five (5) staff and five (5) resident records. LPA also reviewed a sample of the medications. LPA requested the following documents to be submitted to CCLD by 02/12/2026. LIC308 Designation of Administrative Responsibility LIC610E Emergency Disaster Plan (last page) Liability Insurance LIC500 (Personnel report) Administrator certificate LPA observed the following deficiencies: At 10:03am, LPA observed a chair blocking the exit door in bedroom #3. At 10:05am, LPA observed a sink, 3 chairs, 2 trash cans, a mop bucket, and remnants of commodes in back yard. At 10:25am, LPA observed during record review R1 is bedridden and facility does not have a bedridden fire clearance. At 11:05am, LPA observed during record review there was not a hospice care plan for R3 and R4. At 11:15am, LPA observed S1, S3, S4, and S5 are not first aid certified. At 11:44am, LPA observed during record review the medication administrator record (MAR) was not filled out for R1 and R2. Continued on LIC809C. Continued from LIC809C. *An immediate one-time civil penalty for $500.00 will be assessed on today's date for 87202(a)* Deficiency is cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. A copy of the LIC421M, appeal rights, and this report provided.the state’s words, verbatim · CDSS document, Feb 5, 2026

Type of visit: Required - 1 Year

On 02/12/2025 at 9:53AM, Licensing Program Analyst (LPA) T. Syess-Gibson arrived unannounced to conduct Required 1 Year Annual inspection. LPA met with Caregiver, Joy Ballares and explained the purpose of the visit. Administrator, Ronan Rances arrived at 10:28AM. The facility’s fire clearance was approved for four (4) non-ambulatory and two (2) ambulatory residents. Hospice waiver approved for four (4) residents. LPA toured facility with caregiver, Joy Ballares including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of six (6) total bedrooms, one (1) bedroom vacant and one (1) bedroom occupied by staff and two (2) bathrooms. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 68 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 119.2 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of 7-day supply of nonperishable and 2 days of perishable foods. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was purchased on 01/10/2025. First aid kit was observed to be complete. Fire drill last conducted on 02/05/2025. Emergency disaster plan updated 05/05/2024. Continue on LIC809C Continued from LIC809. One (1) staff file reviewed during visit; all other staff files were not available for review during visit. LPA reviewed all four (4) resident records. LPA requested the following documents to be submitted to CCLD by 02/19/2025 LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan (last page) Liability Insurance LPA observed the following deficiencies: At 10:59AM, LPA observed facility didn’t have Pub 475 poster posted. At 11:02AM, LPA observed unlocked garage with Arm & Hammer laundry detergent, Clorox bleach, Tide laundry detergent pods, Ensuno fabric softener, Xtra laundry detergent,Comet, bleach, All-purpose cleaner with bleach, Simple green all-purpose cleaner and Finish powerball dishwasher tabs. At 11:14AM, LPA observed unlocked kitchen cabinet with medications. Civil penalty of $250 is being assessed for repeat violation. At 12:12PM, LPA observed record review no personnel records were at the facility for review. At 12:30PM, LPA observed record review all four(4) residents were missing Pre- Admission Appraisal. Deficiency is cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted and a copy of this report, LIC421FC and appeal rights provided.the state’s words, verbatim · CDSS document, Feb 12, 2025

Type of visit: Required - 1 Year

At approximately 4:15PM, Licensing Program Analysts (LPAs) Carol Fowler and Tonica Syess-Gibson arrived unannounced to conduct a Required 1 Year annual inspection and met with Caregivers, Thelma Hababag and Renato Hababag. Ronan Rances, Administrator arrived at 4:59PM. Facility has an approved fire clearance for 2 ambulatory and 4 non-ambulatory residents for a total capacity of 6 residents. LPAs conducted a tour of the facility and observed the following: the facility was clean and at a comfortable temperature 73 degrees with all exits free from obstruction. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present. Toxins were secure and not accessible to residents. There is a sufficient supply of hygiene products, paper products, and linens available for resident use. LPAs reviewed 5 resident records which were incomplete. LPAs reviewed three (3) staff records which S2 and S3 were incomplete . LPAs reviewed three staff files. Administrator's Certificate #6025731740 was current with an expiration date of 03/06/2024. The facility last fire and evacuation drill was conducted on 01/05/2024. Facility's fire extinguishers were last inspected 01/09/2024. Emergency Disaster Plan updated on 01/08/2024 Smoke detectors and carbon monoxide detectors were tested and operational. The amount of fresh and non-perishable foods are within regulation. Hot water temperatures for all sinks in facility were within Title 22 regulations of 105 to 120 degrees Fahrenheit. Continued on LIC809C. Continued from LIC809. LPA requested the following documents to be submitted to CCLD by 2/28/2024. LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan (last page) Liability Insurance LPAs interviewed one (1) resident. LPAs observed the following deficiencies: At 4:47pm, LPAs observed screen in shared bathroom was ripped. At 4:59pm, LPAs observed unlocked medication in kitchen cabinet. 5:24pm, LPAs observed record review two (2) out of three (3) files reviewed were incomplete. Deficiency is cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted and a copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, Feb 21, 2024