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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609122
Report Date: 10/12/2021
Date Signed: 10/26/2021 12:57:48 PM

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:
10/12/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:48 PM
MET WITH:Kalubi FwanyangaTIME COMPLETED:
03:00 PM
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This is an amended report. On 10/12/21, Licensing Program Analyst (LPA) KaSandra Lopez conducted an unannounced Plan of Correction (POC)/Case Management inspection. When the LPA arrived, there were two staff and six residents present. The LPA spoke with House Manager Robin Aquino at approximately 1:58 PM and advised her of the reason for the inspection.

The purpose for today's inspection is to follow up on the citation issued during the 09/14/2021 Case Management inspection of which the licensee was cited for not having liability insurance. The plan of correction for this citation was due on 09/20/2021. On 09/28/2021, LPA Ashley Morgan conducted a follow up visit to the 09/14/2021 inspection, as the plan of correction had not been met. On 09/28/21, LPA Morgan issued civil penalties for the period 09/21/21 through 09/28/21. LPA Morgan advised civil penalties will accrue until plan of correction is met.

At 1:51 PM the LPA conducted a physical plant tour and no health and safety concerns were observed. At 1:58 PM the LPA spoke with House Manager Robin Aquino. Ms. Aquino stated the facility now has liability insurance and emailed a copy to LPA Lopez during the inspection. LPA Morgan was emailed a copy on 10/07/21 but Ms. Morgan is currently out of the office. LPA Lopez reviewed the document and observed the liability insurance policy effective date to be 09/30/21. However, the document states at the bottom that this is for three (3) facilities. With that, there would be insufficient coverage for each of the three facilities. The document should be specific to Hannah’s Home by Serenity Care Health only. As a result, Civil penalties will continue to accrue and be assessed for the period of 09/29/21 through 10/12/21 at $100 a day ($100 x 14 days.) The penalties will continue to accrue until the plan of correction is met.

Exit interview conducted with Ms. Aquino by phone and the report was signed by Kalubi Fwanyanga. A copy of the report, appeal rights and civil penalty assessment will be emailed to Ms. Aquino.
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Teresa CamaraTELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021
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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