Serenity Family Care Home

Type of visit: Case Management - Other

On 9/2/2025, Licensing Program Analyst (LPA) Arvin Villanueva conducted an unannounced inspection at the facility as part of the closure process. The LPA met with Licensee/Administrator Maria Teresa Villanueva and explained the purpose of the visit. A Notice of Facility Closure had been submitted to the Regional Office, with a proposed closure date of 9/1/2025. The LPA toured the facility with Maria and noted that there were no residents present at the time of the inspection. It is also important to mention that this facility has not had residents in care for over a year. LPA assisted the Licensee to update the resident roster. LPA assisted the Licensee to complete the Facility Closure survey. www.surveymonkey.com/r/facilityclosure LPA obtained the original copy of the facility license. LPA advised Licensee that the facility will be closed in the system as of 9/1/2025. Exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Sep 2, 2025

Type of visit: Required - 1 Year

On 4/18/2025, Licensing Program Analyst Arvin Villanueva (LPA) arrived unannounced at this facility to conduct their required annual inspection visit. LPA met with Administrator Maria Teresa Villanueva and stated the purpose of this visit. Facility is currently does not have any residents in care. Per licensee, she will start admitting residents around May. Facility is currently approved to admit 4 residents receiving hospice services. Facility is approved for 4 non-ambulatory residents. Annual fees are up to date. LPA conducted a physical inspection with the administrator. Facility is a one-story home located in a residential neighborhood. LPA inspected 3 of 4 resident bedrooms. Bedrooms are currently unoccupied but observed to be fully furnished and in good repair at this time. 1 of 4 bedroom (master bedroom) is currently being occupied by the administrators and being utilized as a staff room. 1 of 2 bathroom was inspected and observed to clean and good repair. Hot water temperature was measured at 121 degrees Fahrenheit. Technical advisory was provided to administrator to adjust their hot water heater to ensure hot water is within regulatory standard (between 105 - 120 degrees Fahrenheit) before they start admitting residents. Room temperature during this visit was maintained at 69 degrees Fahrenheit. LPA observed the fireplace to be encased with glass cover. LPA observed carbon monoxide detector in the hallway of the resident bedrooms. LPA observed smoke detectors in each resident bedrooms and hallway by the kitchen. Smoke detectors in 2 resident bedrooms were tested and found to be operable at this time. LPA also observed a pull alarm system. {1 of 2} LPA inspected the outdoor area including the front and backyard. LPA observed pathways to the side exit gate to be clear of obstruction. LPA observed a covered area in the backyard furnished with outdoor furniture.No bodies of water was observed at this time. LPA observed the screen door leading to the backyard to be disrepair at this time. LPA provided advisory to administrator to have it repaired before admitting residents again. Fence and gates were observed to be in good repair at this time. During this visit, LPA conducted record review of 2 staff files. and their Both staff have the following on file: health screen, current First Aid/CPR certificates and current Administrator Certificates. LPA also reviewed facility's infection control plan. No deficiencies are being cited based on today's visit. Exit interview was conducted and a copy of this report was provided. {2 of 2}the state’s words, verbatim · CDSS document, Apr 18, 2025

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 3/14/24 at 10:30 am Licensing Program Analyst (LPA) Arvin Villanueva arrived at this facility unannounced to conduct a required annual inspection visit. LPA met the licensee/administrator in record Maria Teresa Villanueva and explained the purpose of the visit. Per administrator, facility is COVID-free status. Present during this visit were no residents in care and 1 staff members on duty. Per Maria, they are taking a break from providing care and will not be accepting new admission at this time. At 10:45am LPA and administrator toured the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, living area, other common areas, and outside of the facility to ensure compliance with Title 22 regulations. Facility is a single-story home with a fire clearance to serve 4 non-ambulatory elderly residents. Facility is approved for 1 hospice residents. LPA observed the bathroom to contain grab bars, non-skid flooring, close lid trash containers and hygiene supplies. Resident bedrooms were observed to be furnished and unoccupied at this time. The facility common areas are cleaned and furnished. LPA observed the kitchen to be sanitary and free of clutter. Additionally, the kitchen knives and other sharp objects are kept locked. Toxins and cleaning supplies are kept locked in the laundry room. LPA observed the facility to have adequate food supply with at least 2 days’ worth of perishables and 7 days’ worth of non-perishables. LPA observed the dining room to be free of clutter. The front yard and the backyard are observed to be free of obstruction and well maintained. Additionally, the backyard is furnished with outdoor furniture for outdoor activities. Water temperature was measured at 119*F and room temperature was measured at 72*F. Smoke and carbon detectors were in good working condition. Fire extinguisher was serviced on 1/23/24. Medication storage area was observed to be locked and inaccessible. There are no medications to review at this time since there are no residents residing at this facility at this time. First aid kit was observed to have adequate supplies and accessible to staff. {Con't on LIC809-C} {Con't from LIC809} During this inspection 2 former resident files and 2 staffing files were reviewed for regulatory compliance. All files contained required contents including staff training requirements. All staff noted on LIC 500 contained criminal background clearances. Former resident files reviewed contained all required contents including updated admission agreements, medical assessments, and updated appraisal forms as required. Facility’s liability insurance is current and update to date per regulatory requirements. LPA observed personal rights poster. Facility has appropriate internet access available for resident use. LPA observed sufficient equipment and supplies to meet activity program needs of residents in care. LPA reviewed facility’s disaster plan to ensure regulatory compliance. Per administrator, they do not keep a record of quarterly fire drills. LPA provided technical assistance to document their quarterly fire drills. LPA also conducted the inspection using the CARE tool. The facility has an approved infection control plan in place. LPA requested copy of the facility's Liability Insurance, LIC 308 and LIC 500. Per California Code of Regulations, Title 22 and Health and Safety Codes, no deficiencies were observed during this visit. Interview was held with the Maria Teresa Villanueva and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Mar 14, 2024

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.