Serenity Garden Home 2

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Katie Brown arrived unannounced to conduct the annual Inspection. LPA met with and explained the reason for the visit with Administrator (AD) Phoeun Marez. Paperwork to change the Administrator has been submitted, Gina Flores will submit it again to LPA. During this visit, LPA toured the facility inside & out. Resident rooms and common areas were clean, in good repair and contained required furnishings and lighting. LPA observed required items in bathrooms which were clean with hot water measuring 109 degrees. LPA observed hygiene items, paper products, towels, extra bedding, and linens which were available for use. The kitchen was clean, containing necessary cooking items and appliances. LPA observed required food supply, including emergency food. Medications are centrally stored in a locked cabinet in the kitchen. Knives/sharps, cleaning/disinfecting supplies chemicals stored away from food. LPA walked outside to find the grounds well-kept with a shaded seating area. A self-releasing gate was working properly. The fire extinguishers were serviced 5/21/2026. LPA conducted resident and staff file reviews including a medication audit. The Emergency Disaster & Infection Control Plans will be updated and submitted to CCL. See LIC809C for continuation of this report Annual Inspection Page 2 LPA observed the following deficiencies during todays inspection: -Emergency Exit in room 5 was obstructed by a chair from the inside. This door was locked on the inside with an added latch found in the locked position. -Exit for room 1 (Bedridden room) was obstructed by the resident’s bed. The door could not be opened due to the placement of the bed. -Chemicals, cleaning supplies and hygiene supplies were not found to be stored as required per Physician’s Reports of residents in care. -Staff training is not completed as required Deficiencies are being cited in accordance with the California Code of Regulations on the attached LIC 809-D An Immediate Civil Penalty is being assessed for Fire Clearance Violation on the attached LIC412IM An exit interview was conducted and Plan of Correction (POC) developed. During this visit, TSP was discussed and offered to AD. A signed copy of this report and Appeal Rights were provided. LPA requested the following updated forms faxed to CCLD by 8/6/2026- Designation of Facility Responsibility (Lic308), Administrative Organization (Lic309), Personnel Report (LIC 500), Client Roster (LIC 9020) ,Proof of current Liability Coverage and, Infection Control Plan and Emergency Disaster Plan (LIC610E)the state’s words, verbatim · CDSS document, Jul 2, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rachel Bruce arrived unannounced to conduct the Annual inspection. LPA was granted entry by Caregivers Isagani Colocado and Mae Geradine Guillermo. Administrator, Gina Flores was called and arrived shortly thereafter. Facility was toured with Caregiver, Isagani Colocado. During this visit, LPA toured the facility and grounds. During this visit, there were 5 residents present. There are 6 resident rooms, all contained required furnishings and lighting and a TV , the hallway had working night lights. There are 3 bathrooms in this facility. LPA observed grab bars in shower and around toilet, non skid mat in showers, shower chairs, and trash cans with lids. Hot water measured within regulatory requirements. Resident hygiene supplies were properly stored and available. The kitchen was toured observed in good repair with necessary items and appliances and sharps/knives are stored in locked drawer. Cleaning products and dish soap are stored in locked cabinet below sink. Refrigerator was observed to be at 41 degrees F and Freezer at 0 degrees F. LPA observed 2 day perishable and 7 day non perishable food supply available. No expired food observed. There is a second refrigerator located in garage to hold extra food. Medications are centrally stored and locked in kitchen cabinets. Narcotics requiring refrigeration are stored in a locked box in the garage refrigerator. There are 2 fire extinguishers in the facility, one in the laundry room and the second in the kitchen. Both were taken for service during the visit. Smoke and Carbon Monoxide detectors are located in each bedroom and in the common areas. Smoke/carbon detectors was tested and found to be functioning; they are interconnected. Facility has designated visitation areas available inside and out. Doors and passageways are unobstructed throughout the facility. Garage is kept locked. LPA observed locked box of medication in refrigerator for narcotics. Currently there are three residents on hospice. Shelves store extra incontinence and general supplies. First aid kit found to contain required items. Laundry room is kept locked. LPA observed the room and appliances to be in good condition. Cleaning products are stored in locked cabinet. The backyard is well maintained, trees, bushes and grass in good condition. There is a screened pergola with seating for 5. Patio furniture is clean and ready for use. The exterior walkways are free from obstructions and debris. LPA conducted resident and staff file reviews and all contained required information. An exit interview was conducted with Gina Flores, whose signature on this form confirms receipt of these documents.the state’s words, verbatim · CDSS document, May 14, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Lissett Padgett arrived unannounced to conduct the Annual inspection. LPA introduced herself and explained the purpose of the visit, granted entry by Caregiver Isagani Colocado. Licensee, Gina Flores was called and arrived shortly thereafter. Facility was toured with Caregiver, Isagani Colocado. During this visit, LPA toured the facility and grounds. During this visit, there were 5 residents present. There are 6 resident rooms, all contained required furnishings and lighting and a TV. There are 3 bathrooms in this facility. LPA observed grab bars in shower and around toilet, non skid mat in showers, shower chair, trash can with lid. Hot water measured accordingly: Bathroom 1: 105.3 degrees F, Bathroom 2: 111.7 degrees F and Primary bathroom 113.7 degrees F. Resident hygiene supplies were properly stored and available. The kitchen was toured observed in good repair with necessary items and appliances and sharps/knives are stored in locked drawer. Cleaning products and dish soap are stored in locked cabinet. Refrigerator was observed to be at 40 degrees F and Freezer at 0 degrees F. Fire extinguisher attached to wall was serviced on 3/22/2024. LPA observed 2 day perishable and 7 day non perishable food supply available. No expired food observed. Medications are centrally stored and locked. Facility has designated visitation areas available inside and out. Doors and passageways are unobstructed throughout the facility. Garage is kept locked. LPA observed locked medication refrigerator and extra refrigerator for food. Shelves store extra incontinence supplies and PPE supplies. First aid kit found to contain required items. Laundry room is kept locked. LPA observed the room and appliances to be in good condition. Cleaning products are stored in locked cabinet. Fire Extinguishers are located throughout the facility and were serviced in on 3/22/2024. Smoke and Carbon Monoxide detectors are located in each bedroom and in the common areas. Smoke/carbon detectors was tested and found to be functioning; they are interconnected. The backyard is well maintained, trees, bushes and grass in good condition. There is a screened pergola with seating for 5. Patio furniture is clean and ready for use. In a separated fenced area LPA observed a shed with are gardening tools, trash bins. The exterior walkways are free from obstructions and debris. LPA conducted resident and staff file reviews and interviews. An exit interview was conducted with Gina Flores, whose signature on this form confirms receipt of these documents. LPA is requesting the following documents be submitted to the Fresno CCL office by 6/28/24 Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Liability Insurance, Emergency and Disaster Plan (LIC 610D) Personnel Report (LIC500), Register of Facility Clients/Residents for (LIC9020A), Surety Bond, updated facility sketch.the state’s words, verbatim · CDSS document, Jun 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.