198602870-3-12-2024-28-AS-DSIS-D4KTWK-20240422150539

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602870
Report Date: 03/12/2024
Date Signed: 03/12/2024 12:22:41 PM

Unsubstantiated

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
03/05/2024 and conducted by Evaluator Christine Wong

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240305103145

FACILITY NAME:	SERENTO CASA		FACILITY NUMBER:	198602870
ADMINISTRATOR:	SARAH SESAY		FACILITY TYPE:	741
ADDRESS:	1740 SAN DIMAS AVENUE		TELEPHONE:	(909) 394-0304
CITY:	SAN DIMAS	STATE: CA	ZIP CODE:	91773
CAPACITY:	131	CENSUS: 58	DATE:	03/12/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Heather O'Neel		TIME COMPLETED:	12:35 PM

ALLEGATION(S):

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Staff are not providing a healthful and comfortable environment for residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Wong conducted an initial 10 days complaint visit to ascertain information pertaining to the above-mentioned allegation(s) and to establish the validity of the complaint. LPA met with Staff #1 Heather O'neel (Health Services Director) who allowed entry into the facility and was later met by Executive Director Tucker Beugh who assisted with the visit.

The investigation consisted of the following: On today's date, LPA interviewed the executive director, five staff (S1-S5) in the facility and one staff (S6) via telephone and five residnets (R1-R5) and obtained residents and staff roster.

See LIC 9099C for continuation

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323)980-4934
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20240305103145

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: 03/12/2024

NARRATIVE

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The investigation revealed of the following : Allegation "Staff are not providing a healthful and comfortable environment for residents" It's alleged that the staff dog was barking at the resident and roaming around the dining area while residents are eating breakfast or lunch. LPA interviewed five residents and five out of five residents denied the allegation and reported they never heard the staff dog barked and they feel comfortable and safe while the dog is roaming around facility or the dining area. LPA interviewed staff and stated the staff never heard the dog barked in the facility and never saw the dog at the dining area with residents. Staff also stated that the staff dog usually stay at the office in the back. The staff also reported no resident or resident's families had ever complained to them about the staff dog in the facility.

Based on the interviews conducted with the residents and staff, 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.

Per California Code of Regulations, Title 22, no deficiencies were observed or cited during today's visit.

An exit interview was conducted and a copy of this report was provided.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323)980-4934
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2024

LIC9099 (FAS) - (06/04)

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