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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609807
Report Date: 07/13/2022
Date Signed: 07/13/2022 03:02:31 PM

Unsubstantiated


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., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/19/2022 and conducted by Evaluator Jose Gary Tan
COMPLAINT CONTROL NUMBER: 31-AS-20220519124357
FACILITY NAME:SERENITY PATHWAYS, INCFACILITY NUMBER:
197609807
ADMINISTRATOR:ISIKO, FAITH NASSALIFACILITY TYPE:
735
ADDRESS:10522 CEDROS AVETELEPHONE:
(818) 274-2692
CITY:MISSION HILLSSTATE: CAZIP CODE:
91345
CAPACITY:4CENSUS: 4DATE:
07/13/2022
UNANNOUNCEDTIME BEGAN:
11:31 AM
MET WITH:Bernard Isiko - Co administratorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff member hit resident in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) conducted an unannounced subsequent complaint visit to this facility to further investigate the above allegation. LPA met with co administrator Bernard Isiko and explained the reason for the visit.

LPA conducted physical plant tour at 11:35 AM, requested copied of facility documents at 12:01 PM and interviewed staff at 12:35 PM. Regarding the allegation that staff member hit resident in care, it was alleged that Resident #1 (R1) witnessed Staff #1 (S1) slapped Resident #2 (R2). LPA interview with R1 on 05/24/22 at around 12:00 PM revealed that R1 only saw S1 slapping R2 in R1's mind three times (3x) but did not hear the slap nor did R1 saw or hear R2 cried after the "slap". LPA's interview with S1 today at around 12:35 PM today revealed that on the day the alleged incident happened (05/09/22), R2 had just finished dinner and watching TV and S1 was sweeping the floor at the living room when S1 noticed that R2 had a crumb on the face and S1 wiped it. S1 denied ever slapping R2 at anytime. (continued on LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2022
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 31-AS-20220519124357
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., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: SERENITY PATHWAYS, INC
FACILITY NUMBER: 197609807
VISIT DATE: 07/13/2022
NARRATIVE
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(continued from LIC 9099)

LPA's interview with R2's family member (FM) on 05/24/22 at around 10:40 AM revealed that FM never saw during FM's visit at the facility once a week that R2 was mistreated by S1 nor FM believed that S1 would harm S1. Further interview also revealed that FM would have known if S1 or anyone at the facility would have harm S2 as it would show on R2's behavior when R2 is at their home.

Based on the information gathered during the course of the investigation there is insufficient information to support the allegation and therefore deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2