Serenity Care Home RCFE

Type of visit: Required - 1 Year

On 7/29/2026, the Licensing Program Analyst (LPA) Grace Donato arrived unannounced at the facility to conduct a Required 1-Year Annual inspection. The LPA met with the Administrator/Licensee, Olga Senot, and explained the purpose of the visit. LPA toured the facility including all of resident rooms, kitchen area, garage and backyard. While touring the facility it was observed that the room temperature was at 70 deg F. The facility is observed to be clean, odorless, and well maintained. Residents bedrooms were observed to be well organized and fully furnished with adequate lighting. Sharps and toxic materials were observed locked. Food supply in kitchen was observed with an adequate two day perishable and seven day non-perishable food supply. Carbon monoxide/smoke detectors, and fire extinguisher were present throughout the facility. Facility has an updated log for emergency drill is done every quarter. Two resident records and two staff records were reviewed. Centrally stored medication was locked and inaccessible by residents. All medication was labeled and sorted by resident name. All medication logs are complete and updated. No citations issued today. Report is reviewed and copy is provided.the state’s words, verbatim · CDSS document, Jul 29, 2026

Type of visit: Required - 1 Year

On July 09, 2025, the Licensing Program Analyst (LPA) Kiran Jain arrived unannounced at the facility to conduct a Required 1-Year Annual inspection. The LPA met with the caregiver, Josephine Caliboso, and disclosed the purpose of the inspection. The caregiver informed the LPA that the facility had four (4) residents in care and (2) staff members present at the time. The Licensee, Melburga Senot joined shortly after. At 9:15 AM, the LPA initiated a walk-through of the facility, accompanied by the caregiver. LPA inspected the kitchen and there was no food preparation and cooking in progress at the time. The appliances were checked and observed to be in working order. The LPA inspected a locked cabinet containing knives and sharp objects, and a locked cabinet under the sink with detergents and cleaning supplies. The refrigerator and pantry cabinets were inspected, and sufficient supplies of fresh perishable food for (2) days and nonperishable staples for (7) days were observed. No expired food or stored medications were noted. LPA inspected the dining area adjacent to the kitchen. The dining table and chairs were observed to accommodate the residents, and all the furniture was in good repair. Two (2) residents were observed to eat breakfast on the dining table. LPA inspected the living room and observed it clean, with all furniture in good repair. There were sofa sets, reclining chairs, tables, and a television in the living room. There were three (3) bedrooms and (2) bathrooms designated for residents' use. All resident rooms were shared occupancy. Continued on LIC809-C LPA inspected all resident rooms and found them clean, well-lit, and equipped with the required furniture. LPA inspected two (2) shared bathrooms and found them sanitary, and in good working condition. The bathrooms contained soap, grab bars, paper towels, a trash can, a shower chair, and non-slip flooring/mats. At 9:42 AM, the hot water temperature at the sink faucet in both the bathrooms was measured between that range of 126.1°F to 126.7°F. At 09:58 AM, LPA inspected the garage and observed it cluttered with the incontinence supplies, furniture, food supplies, wheelchairs, mattresses, and suitcases. LPA observed a washer and a dryer in the garage. LPA inspected one (1) storage closet in the hallway and observed that they contained clean linens, blankets, and towels for residents’ use. LPA inspected the fire extinguisher mounted on the wall in the living room and found it fully charged, with the last service tag dated 01/31/2025. The caregiver tested the smoke and carbon monoxide detector located in living room in the LPA's presence, and it was found to be functional. Additional smoke and carbon monoxide detectors were observed in all bedrooms and common areas of the facility during the visit. LPA toured the backyard and found ramps and passageways clear of obstructions, with no blocking or tripping hazards. No bodies of water were noted. LPA reviewed two (2) staff personnel records and four (4) resident records. LPA observed that four (4) of four (4) residents had an Admission Agreement, Physician's Report, Appraisal/Needs and Services Plan, and CSDMR. LPA observed that two (2) of two (2) staff members had current First Aid certificates, LIC 508 Criminal Record Statements, and LIC 503 Health Screenings, and confirmed that two (2) of two (2) staff members were associated with the facility. LPA observed a locked centrally stored medication cabinet in the kitchen. Medications were organized separately for each resident. All medication bottles and bubble packs were properly labeled. Centrally Stored Medication Records were reviewed. At 10:50 AM, LPA observed that 1 of 4 residents’ R1’s one prescription medication name, prescription number, and date filled were not entered in the Centrally Stored Medication Records (CSMR). LPA inspected the first aid kit and found it fully stocked. Continued on LIC809-C Emergency Drill Logs were reviewed, and it was observed that Emergency Disaster (Fire and Earthquake) Drills were conducted quarterly, with the most recent drill completed on 07/01/2025. The following updated forms are requested to be submitted to CCLD by 07/16/2025: LIC 500: Personnel Report LIC 308: Designation of Facility Responsibility Certificate of Liability Insurance Administrator Certificate(s) Control of Property (Grant Deed) The deficiencies are being cited based on LPA observations, records reviewed, and interviews conducted in accordance with the California Code of Regulations, Title 22, see LIC809D. An exit interview was conducted, and Plans of Correction were reviewed and developed with the Licensee. A copy of this report and appeal rights were discussed and left with the Licensee, Melburga Senot, whose signature on this form confirms receipt of these documents.the state’s words, verbatim · CDSS document, Jul 9, 2025

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Steve Chang and Marcela Yanez conducted an unannounced annual inspection visit, and met with Administrator (ADM) Melburga Senot. LPAs observed 3 residents and 1 staff in the facility. LPA reviewed 2 residents files and 2 staff files. LPAs toured the facility inside and out and ADM. License, expired Administrator Certificate, and personal rights posters were observed in the facility. ADM showed the evidence that he/she renewed the Administrator certificate already. LPAs toured the facility inside out with ADM. Living room, kitchen, dinning room and two restrooms, 3 resident bedrooms, 1 staff live-in room, and laundry area were inspected. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. Medication closet, knives closet and cleaning product room was observed locked. Room temperature was at 78 degree F, and hot water temperature was at 105 degree F in facility. First aid box, night lights, and flash lights were observed at the facility. The last time the facility conducted the emergency drill is 7/1/2024. Fire extinguisher was serviced on 2/9/2024. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Smoke detectors was tested by staff, and were working fine. Front yard and backyard were inspected. There was no obstruction to block the walkways. No deficiency was noted today. Exit interview was conducted with ADM. This report was provided to ADM for signature.the state’s words, verbatim · CDSS document, Jul 23, 2024

Allegation investigated: Lack of supervision resulting in resident leaving the facility.

On 2/22/24, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced visit to deliver findings for the above allegation. LPA met with Admininstrator Olga Melburga and LPA explained the purpose of the visit. Regarding the allegation of lack of supervision resulting in resident leaving the facility. The reporting party (RP) stated that the primary concern is that the client (R1) wanders a lot and SA may not be able to provide adequate supervision or care. LPA interviewed the admininstrator, Olga Melburga (S1). S1 mentioned that R1 never left the facility unaccompanied or unassisted. S1 is always accompanying R1 whenever he/she goes out of the facility. S1 also brings R1 to do grocery shopping. Based on interviews, the department has determined that that the allegations were false, could not have happened and/or is without a reasonable basis, therefore the allegations are UNFOUNDED. Nothe state’s words, verbatim · CDSS document, Feb 23, 2024 · control 26-AS-20220504135515