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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609122
Report Date: 09/01/2021
Date Signed: 09/01/2021 10:27:51 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:HANNAH'S HOME BY SERENITY CARE HEALTHFACILITY NUMBER:
197609122
ADMINISTRATOR:BIOSEH OGBECHIEFACILITY TYPE:
740
ADDRESS:22740 HATTERAS STTELEPHONE:
(818) 312-9121
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91367
CAPACITY:6CENSUS: 6DATE:
09/01/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Robin AquinoTIME COMPLETED:
10:30 AM
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Licensing Program Analysts (LPAs) Ashley Smith and Teresa Camara made an unannounced Case Management visit to the facility to follow up on the Decision and Order served to the Licensee, Serenity Care Health Corporation, on August 25, 2021. At the time of the visit, there was one (1) staff to six (6) residents. The LPAs were greeted by staff Kabuli Fwanyanga. The LPAs spoke with Robin Aquino via phone and informed them of the reason for the visit. Ms. Aquino confirmed that an additional staff was on shift, but had stepped out for a brief personal errand.

The Decision and Order was serviced to Licensee “Serenity Care Health Corporation” via certified mail on August 25, 2021. A tele-conference was conducted via Microsoft Teams with Licensee Representatives Bioseh Ogbechie, Joseph Chen and Nicolas Spigner, in which the Department reiterated the expectations surrounding the Decision and Order.

The LPA brought a copy of the Decision and Order/CDSS No 6120010302 and ensured that it was posted in a conspicuous location in the facility. During today’s visit, Ms. Fwanyanga posted the Decision and Order and LPAs observed the posting in the hallway. The LPAs inquired as to whether the residents their responsible party were notified about the order. It was confirmed that Ms. Aquino has spoken to all responsible parties regarding the Decision and Order. In addition, the LPAs conducted a brief physical plant tour at 9:55 a.m. During the physical plant tour, the LPAs attempted to speak to the residents regarding the Decision and Order. Copies of the Accusation and Decision and Order were left in the resident’s rooms. The LPAs confirmed that there was sufficient staffing, food, and that the utilities were on at the time of the visit. There were no immediate health and safety concerns observed during today’s visit.

Ms. Aquino was advised that they are not to accept any new admissions during this time.
No deficiencies cited. Exit interview conducted. A copy of the report was issued.
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley SmithTELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2021
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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