Serene Greenfield Manor

Allegation investigated: Questionable death. Licensee neglected resident resulting in a Stage 4 Pressure Injury. Licensee neglected resident resulting in malnourishment. Licensee neglected resident resulting in a rash all over their body which may be scabies.

On January 14, 2026, at 11:00 a.m. Licensing Program Analyst (LPA) Maria (Mita) Partoza, conducted a scheduled video conference meeting via Teams with Administrator/Operations manager (ADM/OM) Jeffrey Chan. LPA stated the purpose of the meeting is to deliver the findings of the complaint received by the Department. On May 27, 2021, the Department received a complaint with the above allegations. Witness 1 (W1) stated that on May 15,2021, a resident (R1) of the facility came into the emergency room with stage 4 pressure injury, malnourished, has rashes that may be scabies, altered mental status, low potassium, and acute kidney injury. Page 1 of 2; See LIC9099C Unfounded On June 01, 2021, the Department conducted an initial 10-day visit investigation, reviewed documents and interviewed the facility administrator/operations manager (ADM/OM) who stated that R1 does not reside at the facility, and no resident by R1s name is receiving hospice services at the time of investigation. The last resident who received a hospice service passed on 05/04/2021. During the initial interview conducted on June 01, 2021, ADM/OM stated that the facility has 3 out of 5 residents who are currently receiving Home Health Aide (HHA) services. ADM/OM stated R1 is unknown to him/her and has no record of the resident. On January 13, 2026, LPA Partoza continued the investigation and conducted a phone interview with ADM/OM, who stated that the facility has changed from Residential Care Facility for the Elderly (RCFE) to Adult Residential Facility (ARF) and was licensed on August 30, 2024. Based on telephone interview with ADM/OM, he/she stated that he/she remembers the complaint and that on June of 2021, CCLD investigated the allegations and requested to review the facility resident records and roster and did not find the person they were looking for. LPA Partoza requested a list of residents from April 2021 to June of 2021. ADM/OM provided the list of residents via email on January 13, 2026 and forwarded communication with prior LPA. LPA Partoza verified the information gathered by LPA Evangelica Torres on June 01, 2021, to the information submitted by ADM/OM. Based on review, R1s name did not appear on either list. This agency has investigated the above complaint allegations, and found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. No deficiencies were cited during today’s meeting based on California Code of Regulation (CCR) Title 22. An exit interview was conducted, and a copy of the report was provided to ADM/OM Jeffrey Chan. Meeting concluded at 12:00 noon of January 14, 2026, signed electronically and delivered via email. End of report Page 2 of 2the state’s words, verbatim · CDSS document, Jan 14, 2026 · control 08-AS-20210527153112

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Angelica Boyles conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Caregiver Benjie Chann and Jessie Chan. According to the facility’s license, the facility serves residents age 60 and over and has a maximum capacity of 6 residents. All residents can be non-ambulatory and there is a hospice waiver for 3 residents. During today’s inspection, there were a total of 4 residents in care, and per medical records, all 4 residents were non-ambulatory and 3 were receiving hospice care. This facility does not feature a secured perimeter or delayed egress doors. LPA, accompanied by Caregiver, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility’s ambient internal temperature was 70 F. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to clients. Medications were labeled, as required, and stored in locked areas. [CONTINUED ON LIC 809C] [CONTINUED FROM LIC 809] No pools or bodies of water were observed on the premises. Per Jessie Chan, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were serviced within the last 12 months. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA interviewed staff and residents. LPA reviewed multiple staff and client records/files. The interviews did not raise any significant licensing concerns. The reviewed files contained required documents. Confidential records were stored in locked areas. Proof of current/active business liability insurance was presented. No deficiencies were observed or cited on today's visit. An exit interview was conducted with Caregiver Jessie Chan, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Apr 2, 2025

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Liliana Silveira conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit with Caregiver Benjie Chan. The Administrator Jeffrey Chan arrived shortly after. According to the facility’s license, the facility serves residents age 60 and over and has a maximum capacity of 6 residents. All residents can be non-ambulatory and there is a hospice waiver for 3 residents. During today’s inspection, there were a total of 5 residents in care, and per medical records, all 5 residents were non-ambulatory. This facility does not feature a secured perimeter or delayed egress doors. LPA, accompanied by Administrator Jeffrey, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility’s ambient internal temperature was 70 F. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to clients. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water were observed on the premises. Per Administrator Jeffrey Chan, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were serviced within the last 12 months. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. (CONTINUED ON LIC 809C) [CONTINUED FROM LIC 809] LPA interviewed staff and residents. LPA reviewed multiple staff and client records/files. The interviews did not raise any significant licensing concerns. The reviewed files contained required documents. Confidential records were stored in locked areas. Jeffrey also presented proof of current/active business liability insurance. No deficiencies were observed or cited during today's annual inspection. An exit interview was conducted with Jeffrey, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Mar 8, 2024