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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392701203
Report Date: 05/24/2024
Date Signed: 06/07/2024 08:40:46 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/01/2024 and conducted by Evaluator Kesha Lewis
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240501121839
FACILITY NAME:SERENE RESIDENTIAL CARE HOMEFACILITY NUMBER:
392701203
ADMINISTRATOR:JIGHERE, VIVIENFACILITY TYPE:
740
ADDRESS:1848 CHATFIELD CIRCLETELEPHONE:
(209) 256-2858
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY:6CENSUS: 5DATE:
05/24/2024
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Ikiseh Chukwudi (Patrick)TIME COMPLETED:
04:15 PM
ALLEGATION(S):
1
2
3
4
5
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7
8
9
Staff denied resident and residents responsible party entry to facility.
Staff did not follow terms of admissions agreement for resident in care.
Staff did not ensure residents personal property was returned to resident.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Kesha Lewis arrived at the facility unannounced deliver findings for the allegations listed above. LPA was greeted by staff and explained the reason for the visit. LPA also spoke with licensee on the phone.

Allegations: Staff denied resident and residents responsible party entry to facility, staff did not follow terms of admissions agreement for resident in care, staff did not ensure residents personal property was returned to resident. After reviewing documentation and videos along with interviews with staff regarding the allegation LPA Lewis finds the complaint to be unsubstantiated.

The facility was able to provide detailed information and show videos and provide proof of a refund being issued. Therefore, this complaint is UNSUBSTANTIATED. A finding that a complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Exit interview conducted. copy of report given.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024
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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