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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602870
Report Date: 05/08/2023
Date Signed: 05/08/2023 04:23:17 PM


Document Has Been Signed on 05/08/2023 04:23 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 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:
05/08/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:11 AM
MET WITH:Administrator Steven Fairchild. Assistant Executive Director Mayra Alfaro, and Heather Oneel, Director of TIME COMPLETED:
04:31 PM
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Licensing Program Analyst (LPA) Alberto Lopez conducted the required annual inspection. LPA arrived unannounced and met with Administrator Steven Fairchild. Assistant Executive Director Mayra Alfaro, and Heather Oneel, House Service director who assisted with visit. This facility consists of: separate dementia unit in the first floor (23 bedrooms), assisted living section has 3 floors (90 bedrooms), recreation area/activity room, dining area, kitchen, reception/office area, beauty salon, laundry room, IT/Data room and (2) courtyards.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Infection Control: The facility staff are using appropriate hand hygiene and gloves while assisting residents and medications. Disposals of trash are done immediately after changing a resident. Staff are still cleaning and disinfecting throughout the day. Facility has sufficient PPE supplies and has an Infection Control Plan posted by the entrance.
Operational Requirements: The facility has plan to accept or retain clients with dementia. There are currently 0 bedridden resident and licensed for 131 non ambulatory residents. The facility has enough liability insurance covering injury to residents and guest.
Physical Plant & Environment Safety: Facility has operable smoke and carbon monoxide combo detectors located in each room and hallway and was tested during visit. Knives, cleaning solutions, and disinfectants are locked in the cabinets. No firearms or weapons are stored at the facility. LPA measured the hot water temperature in the bathrooms and kitchen sink. The hot water temperature in the bathroom and kitchen were measured between 118.9-120 degrees F which is between the required range of 105-120 degrees. F
Planned Activities: Facility has sufficient space to accommodate indoor and outdoor activities. There are sufficient supplies and equipment to meet resident's physical capability.
Food Service: There are sufficient food supplies of 2-day perishable and a week 7 days of non-perishable items. The food is properly stored in the refrigerator to avoid cross contamination.

Due to time constraints, LPA will return another day to complete inspection.

Technical advisories were provided. An exit interview was held. A copy of this report, technical advisory notes, and appeal rights were given to Administrator Steven Fairchild

SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Alberto LopezTELEPHONE: 323-980-4926
LICENSING EVALUATOR SIGNATURE:
DATE: 05/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/08/2023
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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