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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701203
Report Date: 07/22/2024
Date Signed: 07/24/2024 02:03:41 PM

Document Has Been Signed on 07/24/2024 02:03 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:SERENE RESIDENTIAL CARE HOMEFACILITY NUMBER:
392701203
ADMINISTRATOR/
DIRECTOR:
JIGHERE, VIVIENFACILITY TYPE:
740
ADDRESS:1848 CHATFIELD CIRCLETELEPHONE:
(209) 256-2858
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY: 6CENSUS: 6DATE:
07/22/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Chukwudi (Patrick) IkisehTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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Licensing Program Analysts (LPA) Kesha Lewis arrived at the facility unannounced for the purpose of conducting a case management visit. LPA explained purpose of visit to the staff.

The visit is following up on a complaint investigation In March of 2024. R1 paid for the month of March but was not present in the facility from the 21st of march on. The facility rented out the room R1 was occupying but also charged R1 for storage fees. An initial refund was given for $888.00. This amount is found to be incorrect. Storage fees are to be assessed because the facility room is unable to house another resident, but in this case a resident was able to occupy them room. Therefore a total refund of $1,770 is due witch is a prorated amount based on monthly rent divided by 30 days in a month. Another resident moved into the facility into R1'S room on 3/21/2024. $882.00 is still due. On 7/24/24 licensee sent remaining refund to R1'S responsible party.


An exit interview was conducted and a copy of this report was given.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE: DATE: 07/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/22/2024
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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