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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107203958
Report Date: 12/20/2022
Date Signed: 12/20/2022 09:26:04 AM


Document Has Been Signed on 12/20/2022 09:26 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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710



FACILITY NAME:SERENITY LIVING IIFACILITY NUMBER:
107203958
ADMINISTRATOR:JOSIANE P JONESFACILITY TYPE:
740
ADDRESS:1770 W. SAN JOSE AVENUETELEPHONE:
(559) 436-0211
CITY:FRESNOSTATE: CAZIP CODE:
93711
CAPACITY:6CENSUS: DATE:
12/20/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Josiane P Jones, AdministratorTIME COMPLETED:
09:35 AM
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On this date, an office meeting was conducted with Licensee and Administrator Josiane P Jones and Elaine Sauceda to discuss the status of the facility. Present during the meeting were Josiane, Elaine Sauceda, Licensing Program Analyst (LPA) L. Cabrera, Regional Manager (RM) Brenda White, and Licensing Program Manager (LPM) S. Moua.

The Department was informed by Licensee that the facility is closed and she forfeited her license. The property was sold as of 10/12/2022. All residents were relocated.

Exit interview was conducted.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Lady CabreraTELEPHONE: (559) 513-9832
LICENSING EVALUATOR SIGNATURE:
DATE: 12/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/20/2022
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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