SERENITY LIVING

Official classification

Type B

Official code

1569.695(a)

Regulation authority

HSC

What the official deficiency says

(a)In addition to any other requirement of this chapter, a residential care facility for the elderly shall have an emergency and disaster plan that shall include, but not be limited to, all of the following: This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in the emergency disaster plan was incomplete. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/26/2025 Plan of Correction Licensee will provide an updated copy of the emergency disaster plan along with faciltiy sketch to CCL by POC date as proof of correction.

Official classification

Type B

Official code

87468(c)(2)(A)

Regulation authority

CCR

What the official deficiency says

87468 Personal Rights (c) Licensees shall prominently post personal rights, nondiscrimination notice, and complaint information in areas accessible to residents, representatives, and the public. (2) Information on the appropriate reporting agency in case of a complaint or emergency, including procedures for filing confidential complaints, shall be posted as follows: (A) Licensees may use the Residential Care Facility for the Elderly (RCFE) Complaint Poster (PUB 475) or may develop their own poster as provided in this section. A poster developed by the licensee shall contain the same content as the PUB 475. The poster that is posted shall be 20 " x 26 " in size and be posted in the main entryway of the facility. PUB 475 may be accessed, downloaded, and printed from the www.ccld.ca.gov website. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in that PUB 475 was observed in an 8x10 and not in a 20x26 size. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/26/2025 Plan of Correction Licensee stated they will order the posting in the correct size and post. A picture will be sent to CCL by POC date as proof of correction.

Official classification

Type A

Official code

87462(h)(2)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement was not met as evidence by: LPAs observation, the licensee did not comply with the section cited above in that LPAs observed the medication closet off the kitchen to be unlocked and accessible to residents in care. This poses an immediate health, safety and or personal rights risk to residents in care.

Official plan of correction

Training will be completed with all staff. In- service sign in sheet will be completed and submitted to CCL with training material by POC date as proof of correction.

Deadline recorded: Jun 13, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidence by: LPAs observation, the licensee did not comply with the regulation cited above in that, a smell of urine and feces, sufficient lighting was not supplied and the light switch was not functioning in bedroom #3. This poses a potential health safety and or personal rights risk to residents in care.

Official plan of correction

Bedding was immediately removed. In the future bedding will be removed and changed immediately and sanitation will be completed. Training will be completed with all staff. In-serivce sign in sheet and training material will be submitted to CCL by POC date as proof of correction.

Deadline recorded: Jun 13, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87307(a)(3)(A)

Regulation authority

CCR

What the official deficiency says

87307 Personal Accommodations and Services (a) Living accommodations and grounds...The following provisions shall apply: (3) Equipment and supplies necessary...: (A) A bed for each resident...Each bed shall be equipped with good springs, a clean and comfortable mattress, available pillow(s) and lightweight warm bedding. Fillings and covers for mattresses and pillows shall be flame retardant. Rubber sheeting shall be provided when necessary. This requirement was not met as evidence by: LPAs observation, the licensee did not comply with the regulation cited above in that, of bed in bedroom #2 was without box springs. This poses a potential health safety and or personal rights risk to residents in care.

Official plan of correction

Licensee stated they will obtain a letter from the family stating they do not want a box spring for the bed. This will be kept in resident file for future reference. A copy of the letter will be submitted to CCL as proof of correction.

Deadline recorded: Jun 13, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA observation, the licensee did not comply with the section cited above in that the facility was observed with chemicals and items posing a harm to residents in R3's bedroom closet, in the laundry room and in the garage unlocked and accessible to residents in care. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/25/2024 Plan of Correction Items were immediately locked. Licensee will provide all staff training. In-serivce sign in sheets and training material to be provided to CCL by POC date as proof of correction.

Official classification

Type A

Official code

1569.50(a)(4)

Regulation authority

HSC

What the official deficiency says

Conduct that is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the people of the State of California. Based on records reviewed, facility staff financially abused R1. Based on records reviewed, facility staff financially abused R1.

Official plan of correction

Licensee representative will submit a plan to correct and pay back the overpayment due to the resident. The plan will include the amount due, how restitution will be made and the date it will be made by. Proof of the overpayment will be submitted to the CCL office for review.

Deadline recorded: Oct 9, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.657

Regulation authority

HSC

What the official deficiency says

For any rate increase due to a change in the level of care of the resident, the licensee shall provide the resident and the resident’s representative, if any, written notice of the rate increase within two business days after initially providing services at the new level of care. The notice shall include a detailed explanation of the additional services to be provided at the new level of care and an accompanying itemization of the charges. Based on records reviewed, R1 was charged $12,000 when the signed admission agreement states the rate is $6000.00.

Official plan of correction

Licensee representative and all staff will receive training regarding resident’s personal rights, safeguarding resident’s cash, personal property, and valuables, and Administrator Qualifications and Admission Agreement. Training will be completed by a qualified third party agent/person and will include the dates, times, signatures, and topics. Proof of the trainings will be submitted to the CCL office for review.

Deadline recorded: Oct 13, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87217(d)(4)

Regulation authority

CCR

What the official deficiency says

Safeguards for Resident Cash, Personal Property, and Valuables - …no licensee or employee of a facility shall: become the joint tenant on any account specified in Section 87217(h) with a resident. Based on records reviewed, the licensee added herself to R1’s bank account.

Official plan of correction

Licensee representative will submit a plan to correct and pay back the overpayment due to the resident. The plan will include the amount due, how restitution will be made and the date it will be made by. Proof of the plan overpayment will be submitted to the CCL office for review.

Deadline recorded: Oct 9, 2023. A deadline is not proof that correction was completed.