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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 277209225
Report Date: 11/20/2023
Date Signed: 11/21/2023 08:50:27 AM

Document Has Been Signed on 11/21/2023 08:50 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO ASC, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:SERENITY CARE HOMEFACILITY NUMBER:
277209225
ADMINISTRATOR:SUNGLAO, MARIA MFACILITY TYPE:
740
ADDRESS:391 N MADEIRA AVETELEPHONE:
(909) 205-0891
CITY:SALINASSTATE: CAZIP CODE:
93905
CAPACITY: 6CENSUS: 3DATE:
11/20/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Administrator, Jeanette LapitanTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Sarah Hurt arrived unannounced to conduct a Case Management visit on 11/20/23 at 01:30 p.m.. LPA met with facility Administrator, Janette Lapitan and stated the purpose of the visit.

LPA served Decision and Order excluding Staff 1 from being present inside the facility. LPA requested a current and updated Personnel Report (LIC500) and Guardian account be updated to remove S1 from the facility staff roster. A notice of completion shall be submitted to Community Care Licensing (CCL).

LPA informed Administrator that S1 is not allowed to be employed and/or on any facility premises. The Decision and Order of Exclusion From All Facilities came into effect as of 11/17/23 upon receipt of the letter. A copy of the letter was given to the facility during this visit.

Per California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies were observed and cited. Exit interview held with Administrator Jeanette Lapitan, A Copy of report given.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE: DATE: 11/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/20/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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