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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602870
Report Date: 02/09/2024
Date Signed: 02/09/2024 10:40:04 AM


Document Has Been Signed on 02/09/2024 10:40 AM - 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: 21DATE:
02/09/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:08 AM
MET WITH:Heather O'NeelTIME COMPLETED:
10:48 AM
NARRATIVE
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Licensing Program Analyst (LPA) Alberto Lopez conducted an unannounced Plan of Correction Visit (POC
to follow up on the citation issued on 11/03/2023. The purpose of this visit is to follow up the POC that was due on 11/07/23. Upon arriving at the facility, LPA met with Maintenance worker Ian O'Connor, Neil Urbina Plant Ops Director, Health Services Director Heather O”Neel and Executive Director Tucker Brugh and explained the purpose of this visit.

On 01/30/2024 LPA Lopez conducted a case management visit, and the following citation was cited on 01/30/24:

87303 (a)
Maintenance and Operation. The facility shall be clean, safe, sanitary and in good repair at all times. LPA inspected the fire doors with staff Ian O'Conner and doors were working properly at the time of visit. POC was clear.

Exit Interview conducted and copy of the report and appeal rights was provided to the Health Services Director Heather O”Neel.
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Alberto LopezTELEPHONE: 323-980-4926
LICENSING EVALUATOR SIGNATURE:
DATE: 02/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/09/2024
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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