547209023-5-23-2023-24-AS-SPIY-CVNTTP-20230914150103

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 547209023
Report Date: 05/23/2023
Date Signed: 05/23/2023 08:53:37 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/15/2023 and conducted by Evaluator Les Xiong

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20230515114449

FACILITY NAME:	SERENITY SENIOR CARE		FACILITY NUMBER:	547209023
ADMINISTRATOR:	ESQUIVEL, BRIANNA		FACILITY TYPE:	740
ADDRESS:	164 EAST YATES		TELEPHONE:	(559) 719-7510
CITY:	PORTERVILLE	STATE: CA	ZIP CODE:	93257
CAPACITY:	6	CENSUS: 5	DATE:	05/23/2023
		UNANNOUNCED	TIME BEGAN:	07:16 PM
MET WITH:	Brianna Esquivel		TIME COMPLETED:	09:17 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not treat resident with respect
Staff did not provide a safe environment for resident in care
Facility

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) L. Xiong conducted the complaint investigation visit to the facility. I met with the licensee/administrator Brianna Esquivel and informed her the purpose of the visit.
During the course of this investigation LPA toured the facility and interview staff relevant to the complaint investigation. It was determined that the above allegation: Staff did not treat resident with respect, Staff did not provide a safe environment for resident in care and Facility are UNFOUNDED. The evidence from the tour and interviews indicated there was no disrespectful treatment of residents, facility provides safe environment/facility for residents in care. This agency has investigated the complaint alleging (Staff did not treat resident with respect, Staff did not provide a safe environment for resident in care and Facility). We have found that the complaint was unfounded, therefore we have dismissed the complaint.

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Les Xiong
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023

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

LIC9099 (FAS) - (06/04)

Page: 1 of 3