Serenity Home Care II

Type of visit: Required - 1 Year

On 09/30/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct an annual visit. LPA met with Staff Members (SM), Analiza Manganti and Michael Manganti and explained the purpose of the visit. LPA asked SM Maganti to call the Facility Designated Administrator (FDA), Maria Angelica Souxouay to inform her that CCL was present. Shortly after, FDA Souxouay arrived at the facility. This facility 6 residents, of which 5 may be non-ambulatory and 1 may be bedridden. This facility also has a dementia plan on file with a hospice waiver for 6 residents. Current census was 6. A brief interview with FDA Souxouay was conducted. A review of 3 staff files and 6 resident files were conducted. There are currently 4 residents on hospice. All files were current and up to date. The perspective facility administrator has an active administrator certificate #7034066740 and expires on 04/30/2027. A tour of the facility was conducted. Fire extinguisher located by the garage door appeared to have been serviced 07/07/2025 and is in compliance. The kitchen area was toured. LPA Pascua observed a sufficient seven days of non-perishable as well as two days worth of perishable food supplies in the main kitchen. Additional perishable supplies were identified in an additional refrigerator located in the garage. Knives and additional cleaning supplies were locked and made inaccessible to the residents at this time. LPA Pascua observed a locked centralized stored medication cabinet located in the dining room. Along with Administrator, the LPA observed, reviewed, and compared resident medication with the medication dispensing logs. First Aid Kit was present and contained all of the required components. Common areas were toured. Living room, dining area and all other areas intended for resident use were in compliance and good repair. A tour of the garage was conducted. Additional storage for supplies were stored in cabinets. A washer and dryer were also identified in the garage. Laundry detergent, bleach, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time. A tour of the bathrooms was conducted. Hot water temperature was measured and observed to be within the required range of 105-120 degrees. Grab bars were present and in good repair. A tour of the resident bedrooms was conducted. Resident furniture was observed to be sufficient to meet the resident needs at this time. A linen closet was located in the hallway and presented a sufficient amount of linens to adequately supply and meet the needs of the residents at this time. Additional incontinence supplies were also identified. The exterior of the physical plant was in good repair with no hazards present. Perimeter fence was observed to be stable and gates were in good repair. The following forms and documents were requested to be updated and submitted into CCL. -LIC 308 -LIC 400 -LIC 500 -LIC 610 Based on the observations made during today's visit, there are no deficiencies were observed or cited during this annual visit. An exit interview was conducted and a copy of this report was given to Facility Designated Administrator.the state’s words, verbatim · CDSS document, Sep 30, 2025

Type of visit: Post Licensing

On 09/30/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct an annual visit. LPA met with Staff Members (SM), Analiza Manganti and Michael Manganti and explained the purpose of the visit. LPA asked SM Maganti to call the Facility Designated Administrator (FDA), Maria Angelica Souxouay to inform her that CCL was present. Shortly after, FDA Souxouay arrived at the facility. This facility will hold 6 residents, of which 5 may be non-ambulatory and 1 may be bedridden. This facility also has a dementia plan on file with a hospice waiver for 6 residents. Current census was 6. A brief interview with applicant Souxouay was conducted. A review of 3 staff files and 6 resident files were conducted. There are currently 4 residents on hospice. All files were current and up to date. The perspective facility administrator has an active administrator certificate #7034066740 and expires on 04/30/2025. A tour of the facility was conducted. Fire extinguisher located by the garage door appeared to have been purchased on 06/08/2024 and had an attached receipt to it. The kitchen area was toured. LPA Pascua observed a sufficient seven days of non-perishable as well as two days worth of perishable food supplies in the main kitchen. Additional perishable supplies were identified in an additional refrigerator located in the garage. Knives and additional cleaning supplies were locked and made inaccessible to the residents at this time. LPA Pascua observed a locked centralized stored medication cabinet located in the dining room. Along with Administrator, the LPA observed, reviewed, and compared resident medication with the medication dispensing logs. First Aid Kit was present and contained all of the required components. Common areas were toured. Living room, dining area and all other areas intended for resident use were in compliance and good repair. A tour of the garage was conducted. Additional storage for supplies were stored in cabinets. A washer and dryer were also identified in the garage. Laundry detergent, bleach, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time. A tour of the bathrooms was conducted. Hot water temperature was measured and observed to be within the required range of 105-120 degrees. Grab bars were present and in good repair. A tour of the resident bedrooms was conducted. Resident furniture was observed to be sufficient to meet the resident needs at this time. A linen closet was located in the hallway and presented a sufficient amount of linens to adequately supply and meet the needs of the residents at this time. Additional incontinence supplies were also identified. The exterior of the physical plant was in good repair with no hazards present. Perimeter fence was observed to be stable and gates were in good repair. The following forms and documents were requested to be updated and submitted into CCL. -LIC 308 -LIC 400 -LIC 500 -LIC 610 Technical assistance was provided for Section 87458. Based on the observations made during today's visit, there are no deficiencies were observed or cited during this annual visit. An exit interview was conducted and a copy of this report was given to Facility Designated Administrator.the state’s words, verbatim · CDSS document, Sep 30, 2025

Type of visit: Prelicensing

On 10/03/2024, Licensing Program Analyst (LPA) Arielle Pascua arrived announced to this facility to conduct an annual visit. LPA met with applicant, Maria Angelica Souxouay and explained the purpose of the visit. The purpose of this visit was to conduct a Pre-Licensing Visit. This facility will hold 6 residents, of which 5 may be non-ambulatory and 1 may be bedridden. This facility also has a dementia plan on file with a hospice waiver for 6 residents. Current census was 0. A brief interview with applicant Souxouay was conducted. The perspective facility administrator has an active administrator certificate #6016477740 and expires on 04/29/2025. A tour of the facility was conducted. A tour of the kitchen was conducted. LPA observed a sufficient amount of 2-day perishable and 7 day non-perishable food supply. LPA observed knives and toxins locked and made inaccessible to residents in care. A medication cabinet was identified in the cabinet in the kitchen. A fire extinguisher was also located in the kitchen and was purchased on 06/08/2024 with a receipt attached to it. A tour of the back yard was conducted with no hazards present. Perimeter fence and exit gates were observed to be in good repair. A tour of the living area, dining area, and other areas intended for resident use was conducted. Furniture was observed to be in good repair and meet resident needs. A tour of 3 bathrooms were conducted. Hot water was taken to ensure compliance within regulation. Grab bars were present and in good repair. A tour a 4 resident bedrooms were conducted. Resident furniture was observed to be in good repair and meet residents needs. An additional staff bedroom was toured. A tour of the laundry room was conducted. Toxins and other cleaning supplies were identified and made inaccessible to residents in care. A linen closet was identified and presented a sufficient amount of linens to meet the needs of the residents. Emergency lighting was present throughout the home. Carbon monoxide and smoke alarms were observed and tested to ensure it was in proper working condition. The facility temperature was at 72. Based on the observations made during this visit, this applicant has passed the pre-licensing inspection. Component III was reviewed with this applicant. An exit interview was conducted and a copy of this report was provided to the applicant at the end of this visit.the state’s words, verbatim · CDSS document, Oct 3, 2024

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: INITIAL Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Name - Ma. Angelica A. Souxouay CEO/Administrator Interview Method: Telephone interview On September 17, 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, Sep 17, 2024