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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602870
Report Date: 08/19/2022
Date Signed: 08/19/2022 12:44:03 PM


Document Has Been Signed on 08/19/2022 12:44 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
CCLD Regional Office, 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: DATE:
08/19/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Steven Fairchild- Executive DirectorTIME COMPLETED:
12:50 PM
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Licensing Program Analyst's (LPA's) Valeria Maldonado and Kimberly Ramirez made an unannounced Case Management visit at the facility regarding a case of Legionnaire's disease that was reported. LPA's met with Senior Executive Director Tiana Thomas, Executive Director Steven Fairchild, and Plant Operations Manager Carlos Monarrez and explained the purpose for the visit.

During visit today, LPA's requested documentation of the reports for water tests that have been conducted in the facility since June 2022.

Carlos has reported that the water results came back positive in two rooms in the entire community- 1 room in assisted living and 1 room in memory care. The affected room in the assisted living side has been vacant for over a year and the affected room in memory care is currently occupied; However, all the water in that room has been shut off and made inaccessible to the resident. The resident is currently consuming bottled water to drink and to brush their teeth, using the public restroom for toileting, and is being provided bed baths until the facility water has been cleared from Legionnaire's disease. A final water test will be conducted by the testing company on 08/22/22, the aerators in the sinks of all restrooms in the facility will be changed and flushed, and the Department of Public Health has been notified and made aware. The Department of Public Health conducted a visit to the facility on 08/17/22 and did not provide any additional recommendations.

No immediate health and safety concerns were observed or found during today's visit.

An exit interview was conducted with Executive Director Steven Fairchild and Plant Operations Manager Carlos Monarrez, and a copy of the report was provided.
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Valeria MaldonadoTELEPHONE: 323-981-3342
LICENSING EVALUATOR SIGNATURE:
DATE: 08/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/19/2022
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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