Serenitas Care

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Maria (Mita) Partoza, conducted an unannounced Case-management visit to amend the annual required report conducted on 08/04/2026 and to record today's visit. LPA met with administrator (ADM) The following are being amended due to new information: LIC 809C pages 2 and 3 and LIC 809D deficiency citation page to the correct deficiency section. LIC 809D citation page issued on 08/04/2026 is being corrected to 87628 (a)The licensee shall be permitted to accept or retain a resident who has diabetes if the resident is able to perform his/her own glucose testing ...or has it administered by an appropriately skilled professional. Based on interview, S1 to S3 stated - R3 and R1 is not able to perform his/her own glucose testing due to developmental disability. Amended citation is being issued during today's visit based on California Code of Regulations (CCR) Title 22 and a copy of the report was provided to ADM Ann Marie Zarraga.the state’s words, verbatim · CDSS document, Aug 11, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87628(a) · Plan of correction due date: Aug 12, 2026

87628 Diabetes (a)The licensee shall be permitted to accept or retain a resident who has diabetes if the resident is able to perform his/her own glucose testing ...or has it administered by an appropriately skilled professional. This requirement is not met as evidenced by: Based on record review & interviews R2 and R3 are not able to perform their own glucose testing due to developmental disability. S2 and S3 stated they administer sharp lancet glucose test to R2 and R3, which pose/s a immediate health, safety and personal right risk to persons in care.the state’s words, verbatim · CDSS document, Aug 11, 2026

Plan of correction: ADM stated he/she shall submit a memorandum of understanding that staff will adhere the rules and regulations as stipulated on PIN 17-09-ASC in administering finger prick glucose testing by the POC due date of 08/12/2026.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced 1-year required inspection visit. The purpose of this visit was to ensure the licensee’s continued compliance with California Code of Regulations (CCR), Title 22, Division 6. LPA met with the Facility Administrator (ADM) Ann Marie Zarraga. The facility is currently licensed for a 6-bed capacity and has a current census of six (6) ambulatory only residents who have developmental disability at level 5. LPA observed 1 resident at the facility and is not able to verbally communicate clearly. LPA Partoza, inspected the facility inside and outside, including but not limited to the exterior perimeter, walkways, backyard, kitchen, dining, 2 bathrooms, 3 residents' room, 1 staff room, living area and garage. LPA observed the kitchen and dining area was sanitary and organized, knives were locked and not accessible to residents in care without supervision. The medication are in a secured locked cabinet. LPA observed 2 days of perishable food items, and 7 days of non-perishable items in the refrigerator and pantry. LPA inspected 3 resident bedroom, 3 out of 3 bedroom are shared and has sufficient storage (closet and chest drawers) to store the resident's personal belongings. 2 out of 2 bathrooms were inspected, and bathrooms have grab bars and non-skid mats. LPA measured the water temperature for kitchen, and 2 bathroom and temperature ranges from 116.7 degree F in the bathroom and 123 degree F for the kitchen. LPA observed a warning sign in front of the kitchen sink stating "caution water temperature exceeds 125 degree F." page 1 of 3 - This report is being amended due to additional information received (page 2 and 3) LPA observed, that walkways, hallways and exit doors are free from obstructions. LPA reviewed 3 resident record and 3 staff records including but not limited to physician's report, appraisal needs and services plan, centrally stored medication record (CSMDR), medication administration record (MAR), personal and incidental. LPA observed that staff have updated certificates for 1st aid/CPR training, direct support staff training and in-service training including fire and earthquake drills. The facility is equipped with fire extinguishers, smoke and carbon monoxide alarms that are operational. Based on record review conducted, the facility currently provides care and supervision to two (2) residents who are consumers of a placement agency with a Level 5 care designation. Resident #3 (R3) is under 60 years of age. A review of R3's file and logged tracking charts reveals that staff administered health monitoring using a sharp lancet device was originally initiated on 09/09/2024 once daily. A review of logged tracking charts indicates this staff administered the routine test that restarted on 10/15/2025 once daily following a documented shift in clinical tracking data. Documentation shows facility staff completed related operational training on 08/15/2025. A review of the facility's file revealed the licensee does not have a record for under age exception and for restricted health condition exception from the Department for R3. - pursuant to PIN 17-09-ASC, does not require an exception for sharp lancet testing. Sharp lancet testing needs to be administered by a skilled professional. Based on record review and interview, staff are administering the sharp lancet test since 10/15/2025 for R3. Resident #2 (R2). R2 is a senior resident. A review of R2's file and logged tracking charts stated that staff administered health monitoring using a sharp lancet device is continuously administered since 2021 once daily. Documentation shows facility staff completed related operational device training on 09/15/2025 for R2. Based on record review no staff training documentation existed prior to 09/15/2025 for R2. Based on record review the licensee did not have a Restricted Health Condition Exception from the Department for R2. Pursuant to PIN 17-09-ASC, does not require an exception for sharp lancet testing. Sharp lancet testing needs to be administered by a skilled professional. Based on record review and interview, staff are administering the sharp lancet test since 2021 for R1. page 2 of 3 Based on record review and interviews conducted with three out of three (3 of 3) facility staff who were currently on duty at the time of the visit. 3 out of 3 staff confirmed that facility staff are the individuals physically executing the daily health monitoring tests for both R3 and R2 S2 and S3 stated that they perform the finger pricks, load the testing strips, and physically press the operational buttons on the testing devices. S3 demonstrated how the lancet device is used. S1 stated due to R3s behavior of grabbing and throwing, the staff are the ones who administer the glucose test on R3. S1 stated that R2 has difficulty with his/her fine motor skill and makes make administering testing device of R2 to difficult to perform independently even with the hand over hand assistance. Per Department Provider Information Notice (PIN) 17-09-ASC, active physical execution or device manipulation of a health testing device by facility staff constitutes care administration rather than resident self-testing. Based on record review the facility staff are actively administering a restricted health task. The facility did not secure an exceptions for R3 and R2 for restricted health conditions under California Code of Regulations.- Exception is not required, pursuant to PIN 17-09-ASC the regulation is clear that licensees and their designated facility staff are limited to “assistance with self-administration” and are prohibited from “administering” medications, pursuant to Business and Professions Code (BPC) section 4016, unless done so by an appropriately skilled professional acting within their scope of practice, pursuant to CCR, Title 22 section 87101(a)(10). 87612 Restricted Health Conditions (a) The licensee may provide care for residents who have any of the following restricted health conditions, or who require any of the following health services: (5)Diabetes as specified in Section 87628. Citation cited is being corrected to 87628 (a)The licensee shall be permitted to accept or retain a resident who has diabetes if the resident is able to perform his/her own glucose testing ...or has it administered by an appropriately skilled professional. Based on interview, S1 to S3 stated - R3 and R2 is not able to perform their own glucose testing due to developmental disability. During today's visit deficiencies are cited under Title 22 CCR 87612(a)(5). see LIC 809D. An exit interview was conducted with administrator Ann Marie Zarraga and a copy of the report and appeals rights was provided. During today's visit deficiencies are cited under Title 22 CCR 87628(a), see LIC 809D end of report page 3 of 3the state’s words, verbatim · CDSS document, Aug 4, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Administrator Ann Marie Zarraga. During the visit, LPA observed 1 residents and 2 staff. LPA explained the purpose of the visit. LPA toured the facility inside out with ADM which included the Living room, kitchen, dining room, 2 restrooms and 3 residents bedrooms. The staff area of the facility was also inspected. The front yard and backyard were inspected. There was no obstruction to block the walkways. LPA observed a locked storage shed in the backyard of the facility being used as a storage space. Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 75 degrees F, and hot water temperature was measured at 118 degrees F in resident bathrooms. Fire extinguisher was serviced in August 2025. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on July 21, 2025. The facility's emergency and disaster plan was last reviewed on August 29, 2025. Page 1 Out of 2. LPA reviewed facility records for 3 staff and 3 residents. Staff S1's health screening doesn't have the identifying information for the physician who did the health screening. LPA requested to reviewed staff S2's health screening. ADM did not provide LPA with a copy of S2's health screening. ADM stated S2 would get an updated, by next week. LPA reviewed 3 resident medications and centrally stored medication records. LPA reviewed 3 resident P&I records. Deficiencies cited during today's visit. This report was reviewed with Administrator Ann Marie Zarraga and a copy of the signed report was provided. Appeal Rights were provided Page 2 Out of 2. END OF REPORT.the state’s words, verbatim · CDSS document, Aug 29, 2025

Type of visit: Required - 1 Year

On 08/09/2024 at 1:10 p.m. Licensing Program Analysts (LPAs) Maria (Mita) Partoza, Marcela Yanez and Marcella Tarin arrived and conducted an unannounced required 1 year inspection visit. LPA was greeted by 3 staff and the administrator (ADM) Ann Marie Zarraga. LPAs stated the purpose of the visit to ADM. The facility is a Residential Care Facility (RCFE) licensed to serve 60 years and over and approved for 6 ambulatory only. 6 of 6 residents are were present at the time of inspection and are developmentally disabled. At 1:10 p.m. LPA toured the facility inside and outside with ADM, including but not limited to the kitchen, bathroom, dining room, living room, residents rooms, backyard, garage and walkways. The temperature inside the home was at 78 degrees F. LPAs observed a sign posted on the front entry way that states "No Smoking, Oxygen in Use." LPAs with staff (S1) inspected 4 of 4 resident bedrooms. 1 of 4 bedroom is a staff room and 3 of 4 is shared bedroom. LPAs observed 2 bathrooms one on the hallway, and inside the bedroom # (BT1, BT2) LPA observed 3 of 3 resident bedrooms to be organized, sanitary and free from any debris and has sufficient storage for residents' personal belongings. 1 of 3 resident bedroom has a sign posted "no smoking, oxygen in use." 1 of 6 resident uses oxygen as needed and as ordered. LPAs observed that the facility has smoke and carbon monoxide alarm that are in good working condition. LPAs observed hallways, walkways are free from obstruction. LPAs observed the backyard area to be free from debris and is well maintained. LPAs observed a shed in the backyard that stores walkers, facility equipment used by residents in care. The shed has no lock. page 1 of 2 see LIC 809C LPAs observed auditory alarm on the front door. LPAs observed sharps and knives were locked and inaccessible to residents, toxic were observed to be properly stored in locked cabinets. LPAs observe 2 days of perishable food and 7 days non-perishable food. LPAs observed Fire Extinguisher was last serviced on 08/02/2023. LPAs observed refrigerator temperature at 40 degree F, freezer at 0 degree F. LPAs with S1 inspected the garage and observed laundry machine and dryer are in good working. LPAs observe an exit door from the garage that is free from obstruction. LPAs reviewed resident's records, and observed that records are complete and up to date including Centrally Stored Medication and Destruction Record (CSMDR). Medications are labeled and recorded on the CSMDR. LPAs observed First aid Kit to be complete and easily accessible to staff. LPAs reviewed staff record and observed that records are complete and up to date. Certificates for 1st aid was current, annual continuing education training was not documented. The fire and earthquake drill training was last administered in June 29, 2024 and July 5, 2024 respectively. LPAs discussed with ADM the importance of documenting training administered to staff, food safety, thermostat in the freezer and refrigerator to ensure proper temperature is maintained and maintenance of the facility bathroom and screen door by the dining room. Deficiency is cited during today's visit based on California Code of Regulations (CCR) Title 22. See LIC 809D. An exit interview was conducted with ADM Ann Marie Zarraga. A copy of the report and appeals rights were provided.the state’s words, verbatim · CDSS document, Aug 9, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Staff Member Annamarie Zarraga (S1) . During visit, LPA observed 4 residents and 4 staff. LPA toured the facility inside out with S1 which included; the Living room, kitchen, dining room, 2 restrooms and 3 residents bedrooms. The staff area of the facility was also inspected. Front yard and backyard were inspected. There was no obstruction to block the walkways. Two day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication closet, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 70 degrees F, and hot water temperature was measured at 116 degrees F in both resident bathrooms. Fire extinguisher was serviced in August 2, 2023. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by S1, and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on October 15, 2023. LPA reviewed facility records for 3 staff and 3 residents. LPA reviewed 3 resident medications and centrally stored medication records. LPA conducted interviews with 2 staff (S1 to S2) and 2 residents (R1-R2). LPA reviewed 3 resident P & I records. Two residents were at the day program during LPA's visit, and 1 resident had a doctors appointment. No deficiencies cited during today's visit. This report was reviewed with Staff Member Annamarie Zarraga and a copy of the signed report was provided.the state’s words, verbatim · CDSS document, Nov 9, 2023