Simply Serenity Home Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. LPA Tea was greeted and granted entry into the facility by Lead Staff (LS) Crystal Lopez and explained the reason for the visit. Administrator (AD) Norma Roman arrived shortly to assist with the visit. Facility is licensed for six non-ambulatory residents in bedrooms #1, #2, and #3, with an approved hospice waiver for six. Currently there are no residents in care during today's visit. The administrator hopes to have residents for the facility during this year and is awaiting approval for the ALW program. LPA Tea along with the staff toured the facility. LPA toured the physical plant, checked food service, and the first aid kit. The facility is a one-story home with three resident bedrooms, that will be shared rooms, a staff office room, two bathrooms, a living room, a kitchen, a dining area, a breakfast nook, and an attached two car garage. LPA observed smoke detectors/carbon monoxide in common areas and bedrooms to be operational. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 105.6 to 110.1 Fahrenheit degrees. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards; doorways were free of obstructions. First aid kit had all the required elements including dressing, bandages, tweezers, thermometer, and scissors. Kitchen was inspected. Kitchen appliances were slight operational during today's visit. Sharps are locked and stored in a secured box and stored in a kitchen cabinet. Medications are stored in a secured cabinet in the dining are. Emergency food and water were observed in the garage. LPA also observed toxin substances inaccessible to clients in care, locked and secured in cabinets in the garage. The fire extinguishers throughout the facility are fully charged. LPA toured the outside grounds and there was (Annual Inspection continued on LIC9099C) ample seating with shade. There is one exit gate on the righ side of the houset that is self-latching and operational. Living room has books and various reading materials, games, and art activities for potential residents. Also LPA observed light exercise equipment and a basketball shoot out range for the residents. Based on the observation made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with facility and a copy of this report LIC809, 809-C was read and provided to the facility.the state’s words, verbatim · CDSS document, May 4, 2026

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Michael Tea made an announced visit to the facility for the purpose of conducting a pre-licensing inspection. LPA Tea met with designated Administrators (ADs) Norma Roman and Crystal Lopez. An application to operate a Residential Care Facility for Elderly (RCFE) was received by our agency on January 15, 2025, for a total capacity of six; six non ambulatory and six maybe on hospice. Fire clearance was approved by a fire inspector from the Orange County Fire Authority on February 10, 2025. The facility is a one-story home with three resident bedrooms, that will be all shared rooms, a staff office room, two bathrooms, a living room, a kitchen, a dining area, a breakfast nook, and an attached two car garage. All exiting doors inside the facility had alarm notifications. There is one exit gate on the right side of the house that is self-latching and unlocked. There is a shaded seating area and LPA did not observe any obstacles or hazards in the backyard. There is a lovely garden area with plants and flowers. LPA observed the See Something, Say Something poster (PUB 475), Personal Rights, Ombudsman poster, Facility sketch and Emergency Disaster Plan in the facility mounted on the wall around the facility entryway and kitchen. The administrator certificate is hanging in the office, the administrator will display another copy by the front entryway. Fire extinguishers are located in the dining room area and resident hallway, and they are fully charged with an inspection date of April 4 2025. Resident bedrooms had the required furnishings. LPA observed all beds had linens and blankets. All toxic chemicals, cleaning solutions, and disinfectants are inaccessible to residents and will be stored and locked in Continuation of Pre-licensing on LIC 809-C cabinets in the garage. Medications will be stored in a locked cabinet in dining area. The first aid kit is also stored in the locked cabinets in the living room and has all the required elements along with a first aide book. Staff and resident records will also be stored and locked in the cabinets in the staff office room. Reading materials and games were observed in the living room with a phone and computer laptop for residents can use in the kitchen. A supply of two day perishable and seven day non-perishable food was observed and will be maintained on hand. Smoke detectors and carbon monoxide detectors tested operational. Gas burner stove, dishwasher, refrigerator, microwave, washer, and dryer are operational. Hot water temperatures in the bathrooms measured between 109.5 and 114.8 degrees Fahrenheit. Emergency food and water and additional supplies were observed to be well stocked in the garage. The facility is ready to be licensed. LPA conducted the Component Three Orientation with ADs. ADs was notified that the final application approval will be issued by the Centralized Applications Bureau in Sacramento. An exit interview was conducted, and a copy of this report was provided to Licenseethe state’s words, verbatim · CDSS document, Apr 15, 2025