198602870-4-4-2024-28-AS-RORN-D5PUGF-20240528153415

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602870
Report Date: 04/04/2024
Date Signed: 04/04/2024 11:14:10 AM

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
04/02/2024 and conducted by Evaluator Elizabeth Irra

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240402115641

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:	0	CENSUS:	DATE:	04/04/2024
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Charles "Tucker" Brugh and Lisa Gomez		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff do not ensure facility has sufficient amounts of food for residents in care.
Staff does not ensure facility is kept in clean and T.V is not working for residents.
Staff does not ensure sufficient planned activities are provided for residents in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elizabeth Irra conducted a visit to investigate the above allegation. LPA met with Charles "Tucker" Brugh and Lisa Gomez and discussed the purpose of today's visit. Note: This facility has changed ownership effective 04/01/2024.

During this investigation, LPA obtained a copy of the staff and resident rosters, copy of the activity calendar for March 2024 and April 2024, interviewed Staff #1 (S-1) through Staff #4 (S-4), interviewed Resident #1 (R-1) through Resident #5 (R-5) and conducted a tour of the activity rooms, kitchen and T.V. room in the Assisted Living area.

Refer to LIC 9099C for the continuation of this report.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Elizabeth Irra	TELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:	DATE: 04/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2024

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-20240402115641

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: 04/04/2024

NARRATIVE

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Allegation: Staff do not ensure facility has sufficient amounts of food for residents in care. It was alleged that the kitchen does not have enough food for all the residents. LPA conducted a tour of the kitchen and observed sufficient food for residents in care. Staff interviews revealed that there has not been any issues with food supply. Interviewed staff indicated they have not received any complaints/concerns pertaining to food. Interviewed residents had no concerns pertaining to food. Observation and interviews conducted do not corroborate this allegation.

Allegation: Staff does not ensure facility is kept in clean and T.V is not working for residents It was alleged that the activity room is dirty and that the T.V. in living room on Assisted Living does not work. LPA conducted a tour of the activity room and did not observed it to be dirty. LPA also conducted a tour of the activity section located in the T.V. room/dining area and did not observed it to be dirty. LPA also observed the television to be operational with residents watching television during this visit. Staff interviews revealed that the activity rooms are kept clean and that the television has been operational. Interviewed staff indicated they have not received any complaints/concerns pertaining to these matters. Interviewed residents indicated that the activity rooms are kept clean and that the television has been operational. Observation and interviews conducted do not corroborate this allegation.

Allegation: Staff does not ensure sufficient planned activities are provided for residents in care. It was alleged that staff do not do activities other than bingo for residents. LPA obtained a copy of the activity schedule for March 2024 and April 2024. Staff interviews revealed that residents are offered an array of activities other than bingo. Other activities include exercise, morning stretches, zumba, dances, music, puzzles, tennis with balloons, arts and crafts ect.. Interviewed residents indicated that they are offered different activities and not just bingo. Observation, documentation and interviews conducted do not corroborate this allegation

Thus, the investigation revealed that there was insufficient information to support the above mentioned allegations and although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

No deficiencies were noted during this visit per Title 22 Division 6 Chapter 8. Exit interview conducted with Mr. Brugh (Executive Director).

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Elizabeth Irra	TELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:	DATE: 04/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2024

LIC9099 (FAS) - (06/04)

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