Serenity Family Home Care

Type of visit: Required - 1 Year

On 02/13/2026, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced Required -1 Year Annual Visit to the facility listed above. LPA met with Staff, Eusebio Huelar , and the purpose of today’s visit was explained. LPA was granted entry into the facility. The facility is licensed to serve six (6) non-ambulatory residents, two (2) of which maybe bedridden in room #5, and a Hospice Waiver for four (4). Physical Plant/Structure The facility is a single-story structure in a residential neighborhood. The facility consists of five (5) bedrooms, three (3) bathrooms, living area, dining area, kitchen, outside shaded sitting area, and attached garage. LPA observed all walkways outside the facility were clean, clear, and free of hazards, debris, and obstructions. All ramps have secured handrails. LPA did not observe any bodies of water on the premises. Bedrooms LPA inspected all bedrooms and observed them to be clean and in good repair. LPA observed the bedrooms have the required furniture that consists of a bed(s), dresser(s), nightstand(s) with lamps, chair(s), and ample storage space for personal belongings. LPA observed the beds have the required linens including a mattress cover, fitted sheets, blanket, comforter, and pillows. LPA observed an ample supply of linens were observed in a closet in the hallway. Bathrooms LPA inspected the bathrooms and observed they were operational. LPA observed safety handrails secured to the wall. LPA observed an ample supply of hygiene products. LPA observed an ample supply of towels and wash clothes. The water temperatures measured 111.3-degrees, 110.2-degrees, and 112.1-degrees Fahrenheit. Kitchen LPA observed the kitchen clean and sanitary. LPA observed all appliances are operational and in good repair. LPA observed an ample supply of dishware, cookware, and cutlery. LPA observed a 3-day supply of perishable foods and a 7-day supply of non-perishable foods properly stored, labeled, and dated. The water temperature measured 110.6-degrees Fahrenheit. LPA observed sharps and knives secured in a locked drawer in the kitchen and are inaccessible to residents. LPA observed cleaning supplies and toxins secured in the locked cabinet under the kitchen sink and are inaccessible to residents. Common Areas LPA observed the facility appropriately furnished during time of visit. LPA observed in the living room has two (2) recliners, three (3) couches, and two (2) chairs available for resident use. LPA observed games and activities available for residents. The dining room has a large table with chairs to accommodate all residents. LPA observed that all walkways and hallways inside the facility are clean, clear, and free of obstruction and hazards. The facility was maintained at a comfortable temperature. Files LPA reviewed the files for five (5) residents. LPA observed resident’s files have the required documents. LPA reviewed the files for the Administrator and three (3) staff and observed they have the required documents, clearance, certification, and training. LPA observed the administrator’s Administrator Certificate #6070589740 is valid till 06/09/2026. LPA observed required documents posted throughout the facility. LPA received and reviewed a copy of the facility’s liability insurance through Acord that is valid till 10/11/2026. LPA observed the facility’s Licensing Fees are current. Medications LPA observed all Centrally Stored Medications secured in a locked cabinet in the dining area. LPA observed all medications in their original packaging. LPA reviewed the medication and Medications Administration Record (MAR), for five (5) Residents and observed they are consistent with properly documented records. Safety LPA observed smoke and carbon monoxide detectors are operable. The last Emergency Drill was conducted on 01/01/2026. LPA observed two (2) fully charged fire extinguishers last serviced on 06/26/2025. LPA received and reviewed the Emergency and Disaster Plan for Residential Care Facilities for the Elderly. All exits are indicated with an EXIT sign. The facility has a working landline telephone. LPA inspected the First Aid Kit and observed it has the required items and a current manual. Infection Control LPA observed required Infection Control signs posted throughout the facility. Upon entry, LPA observed a sanitizing station that has Visitor Sign-In Logs, hand sanitizer, masks, and gloves available. LPA observed a 30-day supply of Personal Protective Equipment (PPE). LPA observed an ample supply of cleaning supplies. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe any deficiencies therefore NO citations were issued at this time. An exit interview was conducted with Staff, Eusebio Huelar, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Feb 13, 2026

Type of visit: Prelicensing

On 12/20/24, Licensing Program Analyst (LPA), Regina Cloyd, conducted an announced visit to the facility for purpose of a prelicensing evaluation. An application was submitted to CCLD on 09/11/2024, for Change of Ownership for a Residential Care Facility for the Elderly to serve the Elderly for ages 60 years and older. The requested capacity is for six residents, four (4) non-ambulatory and two (2) bedridden. Bedroom #5 is designated for two bedridden residents. Structure: Facility is a five (5) bedroom, three (3) bathroom, single story house with an attached car garage. It includes a kitchen and dining and living room. There is a shaded porch area on the premises. The residents’ bedrooms are spacious and will easily accommodate the residents’ furnishings. Bedrooms Residents: Bedrooms #1 – 4 are for non-ambulatory residents. Bedroom #5 is for two (2) bedridden residents. Bedrooms have beds, chairs, nightstands, adequate lighting, and dressers and/or closets. Bathrooms: All three (3) bathrooms have a working toilet, wash basin, bath-tub/shower. Bedrooms #1 – 2 have private bathrooms. Continue to LIC809-C. Linens & Hygiene Supplies: Beds have the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Adequate supply of linen stored in closet hallway.Emergency Phone Numbers, Exit Plan & Menu: The facility has an active landline. Fire Extinguisher located in the dining room mounted on wall, a second extinguisher is located in the garage. Food Service: Dishes, cups and flat ware are stored in the kitchen cupboards, inspected and in good repair. Knives, cutlery and other sharp kitchen utensils are stored in a locked drawer next to the sink. Food supply adequate stored in the kitchen and in the garage. Dishwasher in kitchen properly installed and functioning. Smoke Detectors: The smoke detectors and carbon monoxide are operational and interconnected. Appliances: Stove burners, oven, microwave, washer, and dryer working. There are two refrigerators in the home, one in the kitchen and one in the garage for additional food storage. Each refrigerator has a measured temperature of at least 45 degrees Fahrenheit for appropriate food storage. Freezer is at (0) zero degrees Fahrenheit. The residence is equipped with central air and heat. Toxins: Locked in kitchen cabinets. Water Temperature: Tested at 118 degrees. Continue to LIC809-C. Medications, First-Aid Kit & Book: A first aid kit has been inspected which has at least the following: thermometer, tweezers, scissors, antiseptic, bandages, gauze and current first aid manual, which are stored in medication cabinet, available for staff use but inaccessible to residents. Clients & Staff Files: Records of staff and residents are stored in a locked cabinet in the dining room. Records were inspected. Reading Material, Games, Equipment & Materials: The facility has board games, books, and other recreational materials for the residents' use. Fire clearance: Fire Clearance with the following special conditions: rooms approved for non-ambulatory/bedridden, approval of delayed egress or delayed egress with secured (locked) perimeter was approved on 11/12/2024. Pre-licensing Checklist: Completed by licensee and reviewed by LPA. Component III: Conducted at the Pre-Licensing visit, information provided about how to operate the facility within substantial compliance. During the prelicensing inspection certain items were observed which do not comply with applicable laws and regulations; the following items must be corrected and proof of correction shall be submitted to the CCLD office to the attention of LPA by 01/07/2025. Continue to LIC809-C. If additional time is required to complete noted items to correct, then the applicant will request an extension in writing prior to the due date. Some items may require a follow up inspection for verification of correction. Prelicensing: 1. Plan of Operation was not available for review. 2. Administrator to add night lights in the passageway to nonprivate bathroom. 3. Administrator to remove obstructions from the perimeter of the facility. 4. Administrator to have a complete personnel file on site. 5. Administrator to submit page 5 of Emergency Disaster Plan. 6. The Licensee to submit general liability insurance for Serenity Family Home Care. 7. Administrator to post Theft & Investigative Procedures. 8. Administrator to post RCFE Complaint Poster (20” x 26”). 9. Administrator to add assembly points from Emergency Disaster Plan to Facility Sketch. An exit interview was conducted and a copy of this report has been furnished to the applicant’s assistant. Accordingly, LPA will submit a copy of this facility evaluation report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application.the state’s words, verbatim · CDSS document, Dec 20, 2024

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: CHOW Capacity: 6 Census (if any clients in care): 6 COMP II Participants: Name - Isaac Luna CEO/ Jasmin Garcia Administrator Interview Method: Telephone interview On November 22, 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 the 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, Nov 22, 2024