Serene Haven Assisted Living Mission Viejo

Allegation investigated: Resident sustained injuries due to physical abuse.

Licensing Program Analyst (LPA) Garlli Tat made an unannounced visit to the facility to deliver the findings on the above allegation. LPA met with the caregiver Adrian Manliclic and explained the purpose of the visit. LPA left a voicemail for Administrator Genaro Salvador to inform them of the visit. During the investigation, LPA inspected the facility, interviewed staff and residents, and reviewed records, including staff roster, resident roster, Resident 1’s (R1) Physician’s Report dated March 6, 2026, R1’s durable power of attorney for health care dated February 25, 2026, R1’s admission agreement dated March 17, 2026, R1’s transfer report, R1’s progress notes, R1’s pre-admission evaluation, and R1’s Physician Orders for Life-Sustaining Treatment (POLST). The investigation into the allegation, resident sustained injuries due to physical abuse, revealed the following. Continued on LIC 9099-C. Unsubstantiated It was reported that R1 sustained an abrasion on their lip and bruising on their face as a result from physical abuse from staff. R1 moved to the facility on March 17, 2026, and moved out of the facility on April 23, 2026. R1 was admitted to the facility on Hospice. R1’s Physician’s Report dated March 6, 2026, shows R1 was diagnosed with Dementia and Traumatic subarachnoid hemorrhage. It was reported on April 20, 2026, that Home Health Worker (HHW) observed redness to R1’s right cheek and they informed the Hospice Company. HHW did not respond to LPA’s request for an interview. It was also reported that the Case Manager for R1 observed redness on R1’s cheek on April 20, 2026. LPA interviewed the Case Manager who reported that they have never witnessed any type of abuse at the facility and that the redness on R1’s face could have been caused by R1 falling asleep with their face on the oxygen tube. R1’s Responsible Party reported they saw R1 on April 21, 2026, and saw a red mark on their cheek and a mark outside of their upper left lip. R1’s Responsible Party reported their concerns to R1’s Hospice Company. R1’s Responsible Party reported that another Family Member reported R1’s upper lip was cut and had bruising on their eye; no date was provided as to when this was observed. LPA attempted to contact this Family Member, but they did not respond to LPA’s request for an interview so this report could not be verified. LPA interviewed R1. R1 reported that a female staff member hit them. R1 did not provide any other relevant information. All the current staff members at the facility are male, including the administrator. No female staff members worked at the facility during R1’s time at the facility. LPA conducted the initial 10-day visit on April 22, 2026. LPA did not observe any injuries on R1. LPA noted that R1 had dried lips and no red marks. Resident 2 (R2) and Resident 3 (R3) reported they have never seen staff or nurses hit residents. Resident 4 (R4) did not respond to LPA’s questions. Three out of three staff interviewed, including the Administrator, stated that they have never hit or abused R1 or any resident. The evidence gathered from the witnesses interviewed and from observations made during the initial 10-day visit are conflicting. There is no physical evidence that R1 suffered any injuries. Therefore, based on the evidence gathered the allegation is deemed Unsubstantiated, meaning that 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. An exit interview was conducted with an authorized representative and a copy of this report, (LIC9099) was provided to the facility representative.the state’s words, verbatim · CDSS document, Jun 15, 2026 · control 22-AS-20260422124146

Type of visit: Required - 1 Year

On November 21, 2025, Licensing Program Analyst (LPA) Garlli Tat conducted an unannounced visit to the facility for the purpose of a required annual inspection. LPA explained the purpose for the visit and was greeted and granted entry by staff on duty. During the visit, staff on duty contacted the facility administrator (AD) Aira Kamil Seleky about the visit. For this visit, there are two staff members on duty, both of which are background cleared and associated. The PUB475 ‘See Something, Say Something’ poster was observed to be located near the front entrance. LPA observed the Administrator's Certificate for Aira Kamil Seleky, which expires on May 27, 2027. The facility is a Residential Care facility for the Elderly (RCFE) licensed for six residents, six of which may be non-ambulatory, none of which may be bedridden, and a hospice waiver for three. LPA toured the interior and exterior portions of the facility with staff. For this visit, there are a total of five non-ambulatory residents in care, three of which are on hospice, and none are bedridden. The facility is a two-story home. There are a total of 11 bedrooms, six of which are private resident bedrooms, and one bedroom is for staff. The upper story consists of four bedrooms, which is vacated by a family. All of which are cleared and associated. LPA toured each bedroom with staff and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and free of any hazards. LPA observed the staff room is kept locked and inaccessible to residents in care. Smoke and carbon monoxide detectors as well as auditory exit alarms were tested and operational. There are a total of three bathrooms. Continued on LIC 809-C. Bathrooms were observed to be in good repair, toilets and faucets were operational and showers were equipped with grab bars and non-skid floor mats. Water temperature in the bathrooms were measured to be between 116.7 and 117.6 degrees Fahrenheit. Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Sharp items and knives were locked in the kitchen cabinet and inaccessible to residents in care. Fire extinguisher was charged, mounted and located in the kitchen. Fire extinguisher was dated and tagged on April 5, 2025. LPA observed the emergency disaster and evacuation plan, which is posted in the dining room. LPA observed the facility conducted their last emergency disaster drill on July 1, 2025. Facility had back-up emergency food and water supply, located in the medication cabinet. LPA observed that the First Aid kit had all the required components. Medications were observed to be locked in a medication cabinet in the dining room, inaccessible to residents in care. Chemicals were observed to be locked underneath the kitchen sink. LPA observed the door leading to the attached one car garage is kept locked and inaccessible to residents in care. The garage is used for storage and laundry. For the exterior portion, LPA observed patio furniture under shading. There are two exit gates in the backyard that can be opened in case of an emergency. No bodies of water were observed. During this visit, five resident files and two staff files were reviewed. All staff are background cleared and associated with the facility. LPA reviewed residents’ medication and medication records and two resident interviews were conducted. Based on today's observations, there are deficiencies being cited per Title 22 of the California Code of Regulations. There are two technical violations issued at the time of the visit. An exit interview was conducted with staff Reymark Gatbonton. This report was reviewed with staff and a copy was provided at the end of the visit. Appeal Rights were reviewed.the state’s words, verbatim · CDSS document, Nov 21, 2025

The state marks this report as 8 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Type of visit: Case Management - Deficiencies

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made a unannounced visit to the facility for the purpose of documenting two Technical Violation Advisory Notes issued to the facility as part of observations made during the investigation of complaint reference #22-AS-20250113154208. During a facility visit conducted on January 17, 2025, it was determined that the facility had re-admitted a resident with a confirmed C. Diff diagnosis on January 16, 2025 after the infection was diagnosed during a hospitalization episode. The investigation conducted did not evidence that facility staff had reported the hospitalization to the Department, nor had staff requested for an exemption to the California Code of Regulations Section 87615(a)(4) regarding Prohibited Health Conditions, which states that: "Staphylococcus aureus ("staph") infection or other serious infection" are health conditions which prohibit the admission or retainer of residents in a residential care facility for the elderly due to the highly contagious nature of the infection. Staff however abided by the instructions of the discharging health professional and proceeded to isolate the resident temporarily as confirmed by the facility visit referenced above. Two Technical Violation Advisory Notes are issued at this time. An exit interview was conducted and a copy of this report was provided to a facility representative.the state’s words, verbatim · CDSS document, Apr 11, 2025

Type of visit: Case Management - Deficiencies

On this day, Licensing Program Analysts (LPAs) Kevin Saborit-Guasch and Nancy Guillen conducted a case management visit to document deficiencies observed during the initial investigation of complaint reference 22-AS-20250113154208 but unrelated to the allegations being investigated. One resident is observed to be assessed as bedridden in both their individual needs assessment and most recent physician report. The facility has one room identified as bedridden, listed as #2 on the facility sketch, however the bedridden resident is observed in bedroom #6. Type A citation issued, immediate civil penalty assessed. Additionally, one resident is observed to have a bed with full rails installed. Resident does however not receive hospice care at the time of the visit. Type B citation issued. As a result of today's observations, two deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report along with appeal rights were provided to a facility representative.the state’s words, verbatim · CDSS document, Jan 17, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87608(a)(5)(B) · Plan of correction due date: Jan 24, 2025

Per CCR 87608(a)(5)(B) Postural Supports "Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails." This requirement is not met as evidenced by: Based on records review and observation, the bed for resident R1 is confirmed to be equipped with full rails. This constitutes a potential risk to the health, safety and personal rights of individuals in care.the state’s words, verbatim · CDSS document, Jan 17, 2025

Plan of correction: Licensee will replace full rails with half rails and ensure to have adequate physician orders on file. Documentation of both to be provided to LPA before the plan of corrections due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87606(c) · Plan of correction due date: Jan 18, 2025

Per CCR 87606(c) Care of Bedridden Residents "To accept or retain a person who is bedridden, other than for a temporary illness or recovery from surgery, a licensee shall obtain and maintain an appropriate fire clearance as specified in Section 87202, Fire Clearance". This requirement is not met as evidenced by: The resident in bedroom #6 has been assessed to be bedridden per their latest physician report. Bedroom #2 only is cleared for bedridden residents. This constitutes an immediate risk to the health, safety and personal rights of individuals in care.the state’s words, verbatim · CDSS document, Jan 17, 2025

Plan of correction: Licensee stated they would seek to obtain an updated physician report that reflects the resident's current condition and submit documentation in support of an appeal. Immediate civil penalty assessed.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Jessica Cho arrived announced for the purpose of conducting a Pre-Licensing visit for a Change of Ownership (CHOW). LPA conducted the visit with Applicant/Administrator Mary ann Salvador and Administrator (Admin) Veahlou Daelto. The initial application to operate a Residential Care Facility for the Elderly (RCFE) was received by the Department of Social Services on April 22, 2024 for age ranges 60 and over, for (6) non-ambulatory residents in bedrooms 1-6 of which (1) may be bedridden in bedroom 2 only. LPA began the tour of the interior and exterior portion of the facility with Caregiver Aira Seleky. Applicant and Administrators arrived approximately 8:00am. The following was observed: Structure: The facility is a two story property in a residential neighborhood. The first floor is comprised of six resident bedrooms and two resident full bathrooms. The second level is not accessible to the residents and is used as a living quarter for relatives of the property owner. The first level is comprised of a formal living room, dining area, kitchen, and an attached two car garage which doubles as a laundry room, and there is a private staff room within the garage. The second level has four bedrooms, one full bathroom, kitchen, dining area, and an office. The backyard has one exit gate, and has sufficient shaded seating area. LPA did not observe any obstacles or hazards in the backyard. Telephone Number: Facility landline number is (949) 446-6718. Signal System: The facility utilizes a signal system where staff is alerted from a central location located from the desk next to Room #6. Smoke and Carbon Monoxide Detectors: The dual functioning smoke detectors/carbon monoxide alert systems and auditory devices were tested and found to be operational. Fire Extinguishers: Three fire extinguishers were mounted, fully charged, and serviced on April 5, 2024. . Fire Clearance: Approved on May 7, 2024. Please note that bedridden approved in Room 2 only. Toxins and Sharps: Cleaning supplies, toxins, and sharps were observed to be secured and inaccessible. Water Temperature: The water temperature in the two resident bathrooms measured at 114.0 and 117.3 degrees Fahrenheit. Medications, First Aid Kit & Manual: The First Aid Kit was checked and found to be in order. The current first aid manual was ordered during the visit. Component III: Component III was completed during today's visit. The Pre-Licensing is now complete, and the facility is ready for licensure. The license will be granted upon completion of a final review and approval from the Licensing Program Manager and the Central Applications Bureau. An exit interview was conducted with Applicant/Administrator Mary Ann Salvador and Administrator Veahlou Daelto, and a copy of this report was provided at the end of the visit. Bedrooms: The resident bedrooms had all required components, are spacious, and easily accommodates the residents’ furnishings. Bathrooms: Bathrooms were clean and operational. Grab bars were secure and bath slip mats were in place. Linens and Hygiene Supplies: Clean linens and hygiene supplies were observed to be fully stocked. Appliances: Stove burners, microwaves, refrigerator, freezer, and washer/dryer were inspected and operating. Resident and Staff Files: Resident and staff records will be maintained on site. Reading Material, Games, Equipment, & Materials: The facility maintains reading material and games in the living room cabinet.. Emergency Phone Numbers/Exit Plan: Posted in the entry way area and available for review. Postings: The See Something, Say Something (PUB475) was posted in the entry way and the Ombudsman Poster was in the hallway. The Rights of the Resident Councils, Resident's Rights, Theft & Loss Policy, and Activity Schedule, were posted on the bulletin boards above the desk. Food Service and Menu: Supply of seven day non-perishable and two day perishables were observed. The sample menu was available for review. The emergency food/water supply was available.the state’s words, verbatim · CDSS document, Nov 1, 2024

Type of visit: Office

Facility Type: RCFE Application Type: CHOW Capacity: 6 Census (if any clients in care): 5 COMP II Participants: Salvador, Maryann and Daelto, Veahlou Allaine - Licensee & Administrator Interview Method: Telephone interview On 10/21/2024, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Oct 21, 2024