Serenity Senior Haven

Type of visit: Post Licensing

At approximately 12:30 PM, Licensing Program Analyst (LPA) Magdaleno arrived unannounced to conduct a post licensing inspection and met with Administrator Cindy Padilla. Facility is a Residential Care Facility for the Elderly (RCFE) with zero (0) residents in care. Facility has a Dementia Care Plan, a Hospice waiver for two (2) and is approved for all non-ambulatory residents where one (1) can be bedridden. LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 12:40 PM, LPA initiated a tour of the facility with Administrator and observed the following: Facility is a one (1) story home, was a comfortable temperature, and passageways were free from obstructions. Facility's fire extinguisher was observed charged and last serviced 4/26. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Water temperature measured 110.6 degrees F and 112.2 degrees F, which is within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. LPA observed at least a two (2) day supply of perishable and seven (7) day supply of non-perishable food, as well as an emergency water supply. Food was found to be stored in a safe manner. There is a shaded seating area in the backyard with outdoor space for activities. Facility has both indoor and outdoors activities planned as well as outings into the community. Continued LIC809C... Continued from LIC809... Facility will conduct quarterly disaster drills for each shift. LPA reviewed emergency disaster plan which was last updated 4/26. LPA observed a supply of PPE, emergency supplies, a first aid kit, and flashlights. Cindy Padilla Administrator Certificate 7010964740 expires 1/24/2028. All fees are current as of this time. Updated copies of the following documents shall be submitted to CCL within 30 days of this visit: Liability Insurance LIC500 - Personnel Report LIC308 - Designation of Responsibility LIC610E - Emergency Disaster Plan No deficiencies cited. Exit interview conducted with Administrator, whose signature on form confirms receipt.the state’s words, verbatim · CDSS document, May 12, 2026

Type of visit: Prelicensing

At approximately 9:50 AM, Licensing Program Analyst (LPA) Magdaleno arrived announced to conduct a Pre-Licensing Inspection and met with Applicant, Cindy Padilla. Facility received an approved fire clearance dated 12/30/2025 that allows for a total capacity of five (5) residents, where four (4) can be non-ambulatory and one (1) can be bedridden. Facility plans to be a Residential Care Facility for the Elderly (RCFE) At approximately 10:00 AM LPA conducted a walk-through of facility with Applicant and observed the following: Per facility sketch, facility is a one story residence with three(3) residents bedrooms, two (2) bathrooms, a living room, a dining room, a family room, a laundry room, an office, and a garage. Facility was found to be clean and at a comfortable temperature with all exits free from obstructions. Facility has an Infection Control plan on file. Facility will maintain food levels as per Title 22 regulations. Facility has sufficient items for cooking and serving. Facility will maintain water temperatures for all sinks within Title 22 Regulations of 105 degree F to 120 degrees F. There was a sufficient supply of cleaning products, linens, hygiene products, and paper products available for residents. Toxins will be locked in laundry room and inaccessible to residents. Bathrooms were equipped with necessary grab bars, and non-slip floors mats were present. All resident rooms were furnished with a bed, lamp, dresser, and chairs. Medication cabinet was observed with a lock and files will be kept in locked drawer in office. Facility has indoor/outdoor areas for visiting and activities. Facility's fire extinguisher was observed to be charged and last inspected 3/25. Facility's smoke and carbon monoxide detectors were tested and operational. LPA confirmed that contents of the facility's First Aid Kit was sufficient. Facility has internet accessible devices and internet available for residents in care. LPA and Applicant discussed many topics including reporting requirements, documentation requirements, grievance procedures, staffing, disaster drills, and yearly training requirements. No Deficiencies or Advisories given during visit. Pre-Licensing completed and Component III presentation conducted with Applicant. Facility is ready to be Licensed as a Residential Care Facility for the Elderly (RCFE). LPA will submit Pre-Licensing Application Report to the Application Unit Analyst in Sacramento. Application Unit Analyst will notify Applicant of Status. Exit interview conducted with Applicant, whose signature on form confirms receipt.the state’s words, verbatim · CDSS document, Jan 21, 2026

Type of visit: Office

Component II completion: Successful Facility Type: Residential Care Facility for the Elderly (RCFE) Application Type: Initial Capacity: 5 Census (if any clients in care): none COMP II Participants: Cindy Padilla, Applicant/Administrator Interview Method: Virtual interview (Microsoft Teams) On December 12, 2025, Applicant/Administrator participated in COMP II. Identification of the Applicant/Aministrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, Applicant/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 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, Dec 12, 2025