Serenity Manor

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Tihesha Smith conducted an unannounced Required 1-year inspection at this facility. LPA was greeted by staff and disclosed the purpose of the visit. The administrator was not present and staff contacted licensee and designee arrived later. LPA conducted a tour of the physical plant at approximately 8:40 am to ensure there are no health and safety hazards, and facility is in compliance with Title 22 Regulations. Common areas were observed for the ability to safely serve the needs of the residents. These included the kitchen, dining room, and living room. The common areas were checked for cleanliness and furniture was checked for functionality. Common areas observed to be furnished appropriately with adequate seating for residents. LPA reviewed the food service areas, food storage and supply (perishable and nonperishable foods). The kitchen food supply was observed and sufficient for the six (6) residents currently residing there. Two (2) days of perishable food observed. The freezer is stocked with meats and frozen vegetables. Sharps are stored in locked kitchen island drawer. The residents’ medications and first aid kit were stored in locked kitchen cabinet next to glass door and were observed to be locked and inaccessible to residents. There are two (2) fire extinguisher on the floor in the kitchen next to medication cabinet and observed to be charged. The facility has a total of seven (7) bedrooms and five (5) bathrooms, The six (6) residents’ bedrooms were properly furnished with at least one chair, nightstand, and sufficient lighting for each resident. The bedrooms (cont from 809) had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. LPA observed a supply of linens and hygiene supply in hall closet. Facility phone observed to be operational. Each bathroom had the following items available: hand soap, paper towels, and trash cans. The hot water temperature was measured in bathrooms to ensure it was within the required range for residents’ comfort and safety. The water temperature range was measured at 119.8 and 123.7-degrees Fahrenheit for the bathrooms. Attached Garage: contained laundry appliances observed to be in good repair. Additional supplies, incontinence supplies, and toxins stored and inaccessible to residents. Pool in backyard is enclosed, locked and inaccessible. Backyard also has a shaded patio area and furniture observed to be in good condition. Smoke detectors/carbon monoxide detector were tested and operable at time of visit. At approximately 09:20 am, LPA Smith reviewed random files for residents and staff. Resident and staff files contained appropriate documentation. Facility grounds were free of hazards /No Deficiencies cited Exit Interview Conducted / A Copy of the Report Issuedthe state’s words, verbatim · CDSS document, Feb 22, 2026

Type of visit: Required - 1 Year

At approximately 10:30 a.m. on 02/19/2025, Licensing Program Analyst (LPAs) Nicholas Reed conducted an unannounced annual inspection. LPA met with staff and later the administrator and disclosed the reason for the visit. A file review was conducted prior to today’s visit. The facility was last visited on 12/27/2023 for an annual visit. It is a single story building with seven (07) bedrooms, five (05) bathrooms, kitchen, laundry room, common areas, and outdoor areas. It has an approved fire clearance for six (06) nonambulatory residents, of which six (06) may be bedridden. Approved hospice waivers for six (06). LPA observed a maintained front yard. A screening station at the front contained sanitizer and a visitor log. Postings at the front included COVID precautions, facility license, confidential complaints contacts, ombudsman contacts, neighborhood complaint procedures, theft and loss policy, rights of resident councils, and personal rights. Walls, floors, windows, screens, and blinds were clean and in good repair. At 10:40 a.m. LPA measured the room temperature to be 71 degrees Fahrenheit. The living room contained a television, reading material, games, a piano, and furniture in good repair. The facility has seven (07) bedrooms. One (01) bedroom is designated as a staff room. The staff room was unlocked and free of hazards. All bedrooms contained a chair, lamp, nightstand, storage, bed alarms, and a bed with adequate bedding. At approximately 11:00 a.m., three (03) beds were observed with bedrails attached but not in use. The administrator explained that bedrails are never used at night but only during the day to assist with grooming. All furnishings were clean and in good condition. All rooms had hospital beds with wheels in the locked position. The facility has five (05) bathrooms. Four (04) bathrooms are private and one (01) is shared. All bathrooms contained liquid soap, paper towels, trash can with a tight fitting lid, and grab bars near the toilet and shower or commodes with grab bars. At approximately 11:10 a.m. LPA measured the water temperature in the shared bathroom to be 108.2 degrees Fahrenheit. LPA used the house telephone at 11:15 a.m. The phone was deemed operational. LPA observed an adequate supply of perishable and non-perishable foods in the kitchen and garage. Appliances were in good condition. Sharps were locked under the island counter top. The garage area was locked and contained a washing machine, a dryer, extra paper and incontinence supplies, medications, and chemicals. Both appliances were in working order. Detergents and cleaning supplies were locked near the appliances. LPA observed a shaded patio area in the rear of the facility. The patio contained furniture in good condition. A pool was gated, locked, and inaccessible. Two (02) out of two (02) emergency exit paths were free from obstructions. Exit gates were unlocked with inward facing latches. Eight (08) out of eight (08) auditory alarms were turned on and functioning. Fire sprinklers were located throughout the facility. At 12:30 p.m., smoke and carbon monoxide detectors were tested and operational. Detectors were hard-wired and operated simultaneously. At approximately 12:35 p.m. LPA observed a fully charged fire extinguisher in the kitchen. It was purchased on 10/04/2024 with a receipt attached. At 12:45 p.m., LPA observed a complete first aid kit locked near the kitchen. At 12:50 p.m. LPAs reviewed staff and resident files. All files were complete and available for audit. During today's inspection, the facility was in compliance with Title 22 regulations. No immediate health or safety hazards were observed. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, Feb 19, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced one (1) year required annual visit to the facility. LPA met with Administrator Michelle Weisman and explained the purpose of the visit. A tour of the physical plant was conducted at 1:22 PM and the following was noted: The facility has 7 bedrooms and 5 bathrooms currently occupying 5 residents. The facility is fire cleared for 6 non-ambulatory residents, of which 6 may be bedridden. Hospice waiver for 6 residents. There are 6 private resident rooms and one staff room. Living and dining room furniture were also checked. The living room is neat and clean along with the dining room. The facility maintains a comfortable temperature at 72°F. The dual smoke and carbon monoxide detectors are hardwired and interconnected and observed to be operational. Fire extinguisher is located in the kitchen and observed to be full and last purchased on 02/01/2022. The facility is equipped with fire sprinklers. The backyard of the facility has outdoor furniture, with a covered shaded area for clients. There is a swimming pool that is appropriately fenced and locked in the facility. The garage is currently being partially used as a storage facility. Laundry room is also located in the garage. Laundry detergents, cleaning agents and other toxins are stored in a locked cabinet in the kitchen. Food Service/Kitchen area was sufficiently stocked with two (2) days perishable and seven (7) days non-perishable food. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Knives and sharps are observed to be locked in a kitchen drawer and inaccessible to residents Continue on 9099-C The Clients' rooms are adequately furnished with appropriate furniture and lighting system. Hallways/passageways are lit. Clients have a sufficient amount of personal hygiene product provided by the licensee. Staff Room: Staff room was observed to be locked and located adjacent to the dining room. No medications were observed in the staff room. The bathroom was checked for cleanliness and proper operations. LPA observed the appropriate grab bars in the toilet and shower. The hot water temperature was measured at a range of 120°F. Towels and washcloths are not shared. There was enough clean linen available in stock at the cabinet. Medications: LPAs observed medication cabinet to be locked and inaccessible to residents, located near the dining area. There is a complete first aid kit located inside the dining area. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Dec 27, 2023