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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609122
Report Date: 02/08/2022
Date Signed: 02/08/2022 02:56:29 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/31/2022 and conducted by Evaluator Elsie Campos
COMPLAINT CONTROL NUMBER: 29-NP-20220131174140
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: ZIP CODE:
91367
CAPACITY:6CENSUS: 4DATE:
02/08/2022
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Robin Aquino-House ManagerTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Licensee charged an unauthorized fee
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA’s) Elsie Campos conducted an unannounced complaint visit to the facility today. The LPA met with staff and explained the reason for the visit. There was (2) two staff and (4) four residents present. The Administrator Robin Aquino arrived at the facility shortly thereafter and LPA explained the reason for the visit.

During today’s visit, the LPA interviewed staff at 11:02 a.m.,11:04 a.m. and 11:20 a.m. and 11:30 a.m.; interviewed resident family member at 2:10 p.m. and reviewed records at 11:50 a.m.
Regarding the allegation it was alleged that the licensee charged an unauthorize fee. Staff interviews revealed that the licensee had issued a notice on January 28, 2022 indicating that a temporary fee would be applied to the resident’s bill moving forward effective February 1st, 2022.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie CamposTELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2022
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 2
Control Number 29-NP-20220131174140
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 HEALTH
FACILITY NUMBER: 197609122
VISIT DATE: 02/08/2022
NARRATIVE
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The LPA spoke to the executive director Joe Chen and the house manager Robin Aquino and confirmed that the temporary fee was not assessed, and at this time the notice is being reconsidered. During today’s visit the LPA reviewed (4) four February resident invoices and confirmed the $129/month fee was not assessed. The LPA also spoke to resident family member who confirmed that the February invoice did not include this temporary fee.

Based on the investigation there is insufficient evidence to support the claim that the licensee charged an unauthorized fee. This allegation is deemed unsubstantiated at this time.

No deficiencies cited regarding the complaint.

Exit interview conducted and a copy of the report was issued.
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie CamposTELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2