198320470-4-3-2026-11-AS-UCOL-DT8S8W-20260417133951

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320470
Report Date: 04/03/2026
Date Signed: 04/03/2026 02:20:45 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/24/2026 and conducted by Evaluator Regina Cloyd

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20260324110344

FACILITY NAME:	SERENITY SENIORS HOME		FACILITY NUMBER:	198320470
ADMINISTRATOR:	RICHARDSON, ANTOINETTE		FACILITY TYPE:	740
ADDRESS:	14043 S NORTHWOOD AVE		TELEPHONE:	(310) 763-7879
CITY:	COMPTON	STATE: CA	ZIP CODE:	90222
CAPACITY:	4	CENSUS: 4	DATE:	04/03/2026
		UNANNOUNCED	TIME BEGAN:	01:57 PM
MET WITH:	Maya Astier		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff mismanages residents' medications.

INVESTIGATION FINDINGS:

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On 04/03/2026, Licensing Program Analyst (LPA) Regina Cloyd conducted a subsequent visit to gather information regarding the above allegation. LPA met with met with Staff and spoke with Licensee Maya Astier over the phone and the purpose of the visit was explained.

Investigation consisted of the following: On 04/02/2026, LPA obtained Personnel Report, Register of Residents, Menu (March and April 2026), Pest Control Invoice and Residents #1 - #4 Emergency Contact, Physician’s Report, Patient Visit Summary, IPP, and Medication Administration Records (February 1, 2026 – April 2, 2026). LPA interviewed Staff #1 – 4 and Witness #1 – 4 and toured the kitchen area. On 04/03/26, LPA received discontinuation pharmacy orders for R4.

Investigation revealed the following:
Regarding the allegation, “Staff mismanages residents' medications,” it is being alleged staff will not pass out medications as prescribed and will give PRNs when they are not requested. Continue to LIC9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:	DATE: 04/03/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20260324110344

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: SERENITY SENIORS HOME	FACILITY NUMBER: 198320470
	VISIT DATE: 04/03/2026

NARRATIVE

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Record review of Medication Administration Record (MAR) for Resident’s #1 - #4 revealed residents received their routine and PRN medication as prescribed. R1 received Lorazepam 1 MG as needed for anxiety (for use in school or after). R1 took it on 3/11/26, 3/24/26, 3/31/26 due to extreme anxiety and R1’s response to the medication was documented. R2 received Lorazepam (as needed for anxiety) on 02/18/26 2pm for anxiety and R2’s response to the medication was documented. R2 received Tylenol (as needed for pain) on 02/28/26, 03/01/26 - 03/04/26 and R2’s response to the medication was documented. R3's MAR revealed Lorazepam 0.5 (as needed for extreme anxiety) was given on 03/18/26, 03/19/26, and 03/21/26 for anxiety and R3’s response to the medication was documented. S1 - S2 indicated medication is provided according to MAR sheet and PRN is given when residents are experiencing behaviors. It is documented on the MAR. Interview with Responsible Parties (W1 – W3) denied the allegation.

Regarding the allegation, “Staff mismanages residents' medications.,” based on record reviews and interviews, the Department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, as a result, the allegation is Unsubstantiated.

No deficiencies were cited.

An exit interview was conducted and a copy of this report was read to the Licensee Maya Astier over the phone and provided to Staff.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:	DATE: 04/03/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2026

LIC9099 (FAS) - (06/04)

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