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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602870
Report Date: 04/14/2023
Date Signed: 04/14/2023 02:57:18 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/10/2023 and conducted by Evaluator Alberto Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20230410105221
FACILITY NAME:SERENTO CASAFACILITY NUMBER:
198602870
ADMINISTRATOR:SARAH SESAYFACILITY TYPE:
741
ADDRESS:1740 SAN DIMAS AVENUETELEPHONE:
(909) 394-0304
CITY:SAN DIMASSTATE: CAZIP CODE:
91773
CAPACITY:131CENSUS: 66DATE:
04/14/2023
UNANNOUNCEDTIME BEGAN:
10:22 AM
MET WITH:Mayra Alfaro Assistant Executive DirectorTIME COMPLETED:
03:06 PM
ALLEGATION(S):
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Facility is malodorous
Staff failed to provide a safe and comfortable environment
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Lopez conducted a complaint investigation for the allegations listed above. LPA was greeted by staff Monique Trejo, HR Director Nadia Batista and Assistant Executive Director Mayra Alfaro later joined LPA and LPA discussed purpose of the visit.

The investigation consisted of the following: LPA reviewed and obtained copies of facility resident roster and staff roster and facility Infection control plan, Interviews were conducted with five (S1-S5) facility staff which included Plant Ops Director and Plant Ops Tech. Interviews were also conducted residents 1-7 (R1-R7) and with R1’s family member (V1)

Regarding allegation: Facility is Malodorous

(Continued on 9099C)
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Alberto LopezTELEPHONE: 323-980-4926
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/10/2023 and conducted by Evaluator Alberto Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20230410105221

FACILITY NAME:SERENTO CASAFACILITY NUMBER:
198602870
ADMINISTRATOR:SARAH SESAYFACILITY TYPE:
741
ADDRESS:1740 SAN DIMAS AVENUETELEPHONE:
(909) 394-0304
CITY:SAN DIMASSTATE: CAZIP CODE:
91773
CAPACITY:131CENSUS: 66DATE:
04/14/2023
UNANNOUNCEDTIME BEGAN:
10:22 AM
MET WITH:Mayra Alfaro Assistant Executive DirectorTIME COMPLETED:
03:06 PM
ALLEGATION(S):
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9
Facility is in disrepair
INVESTIGATION FINDINGS:
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Regarding allegation: Facility is in disrepair

It was never alleged that facility was in disrepair. LPA interviewed five staff and all staff denied the allegations. LPA interviewed 7 residents and 7 of 7 could not collaborate the allegation. LPA interviewed (V1) and V1 could not collaborate the allegation.V1 stated the facility is in excellent condition and not is disrepair. All residents stated that everything works in their rooms and not aware of facility being in disrepair. All residents stated they are satisfied with facility.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

An exit interview was conducted and a copy of this report was provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Alberto LopezTELEPHONE: 323-980-4926
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 28-AS-20230410105221
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: SERENTO CASA
FACILITY NUMBER: 198602870
VISIT DATE: 04/14/2023
NARRATIVE
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(Continued from 9099) ****This 9099C report was amended to removed incorrect information and nothing else and findings remain the same.****

It is alleged that a odor of raw sewage is coming from the shower drains of some of the rooms where showers are not currently used. LPA interviewed 5 staff and 4 of 5 staff stated they are aware of the issue and are attempting to resolve it by running water through the drains of showers not used. Plant Ops Director stated that the P joint is designed to prevent odors from coming into the rooms, however if the drains are not used, it can cause the water in the P joint to dry up and the odors will enter the room. This is the cause of the odor. 3/7 residents stated they smell the odor which smells like sewage and one resident showed LPA the hallway area where the smell is coming from. LPA smelled an odor in the shower in room 223 while inspecting the room. RP claimed that the odor was causing Legionnaires' Disease. There was one (1) isolated case of Legionnaires disease in May of 2022, and the Department of Public Health was involved.LPA checked all the empty rooms on 2nd floor 222,233,237,262, and 266, and none had standing water and one ( room 262) had a bad odor coming from the restroom area.

Regarding allegation: Staff failed to provide a safe and comfortable environment

It is alleged that due to facility neglect in resolving the odor in the facility, it is not providing a safe and comfortable environment in the facility. R1 stated the odor in R1 restroom is unbearable and makes R1 environment uncomfortable to live in and R1 stated developed sinus issues. Facility offered to move R1 to another room and R1 denied offer. R1 confirmed this to LPA. R5 stated there is an unpleasant order in the hallway by room 223 that smells like raw sewage. LPA interviewed five staff and all five staff agreed that odor is preventing facility from providing a safe and comfortable environment for resident. One staff S4 stated S4 would not want the smell in S4 home. Due to the ongoing odor, the facility failed to provide a safe and comfortable environment for residents, staff and visitors.

Based on LPA’s observations and interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, (Title 22, Division & Chapter number), are being cited on the attached LIC 9099D.



An exit interview was conducted, and a copy of this report was provided along with the Appeals Rights.
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Alberto LopezTELEPHONE: 323-980-4926
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 28-AS-20230410105221
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: SERENTO CASA
FACILITY NUMBER: 198602870
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/21/2023
Section Cited
CCR
87303(a)
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Maintenance and Operation. The facility shall be clean, safe, sanitary and in good repair at all times.

This requirement was not met as evidenced by:
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Facility will send written plan of how they will address the odor and correct it and send written plan and proof that is odor issue is resolved to LPA by POC date. Facility will also test the water and send results to LPA by POC.
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Facility hallway near room 223 and room 223 and 262 bathroom have a odor of sewage coming from the shower drain. Which poses a health and safety hazard to residents, staff and visitors.
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Type B
04/21/2023
Section Cited
CCR
87468.1(a)(2)
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87468.1 (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:

(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.

This requirement was not met as evidenced by:
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Facility will create a written plan on how they will address the odor issue and send it to LPA by POC date.
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Due to odor in hallway near room 223 and in room 223, the facility failed to comply with this requirement
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Alberto LopezTELEPHONE: 323-980-4926
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4