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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005294
Report Date: 06/05/2020
Date Signed: 06/05/2020 10:12:11 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:SERENE SENIOR CAREFACILITY NUMBER:
306005294
ADMINISTRATOR:TADEO, CYNTHIAFACILITY TYPE:
740
ADDRESS:13092 NEWLAND STREETTELEPHONE:
(657) 263-4988
CITY:GARDEN GROVESTATE: CAZIP CODE:
92844
CAPACITY:6CENSUS: 4DATE:
06/05/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Geisel Sanchez, AdministratorTIME COMPLETED:
10:11 AM
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On June 5, 2020 Licensing Program Analyst (LPA) Rosie Quiroz contacted Administrator (AD) Geisel Sanchez via telephone and discussed the purpose of today's case management being conducted via tele visit due to COVID-19 and pre-cautionary measures.
Today's tele visit case management is to deliver two amended reports for COMPLAINT CONTROL NUMBER: 22-AS-20200214075808 investigation findings which were delivered during a visit conducted on 2/20/2020.
LPA Quiroz reviewed amended reports with AD Geisel Sanchez with original date of 2/20/2020 and addressed any concerns and/or questions regarding the amendment of the reports. AD Geisel Sanchez did not have any concerns or questions.
An exit interview was conducted with Administrator Geisel Sanchez via telephone. This report and two amended reports were sent via email and an electronic email read receipt confirms receiving of the reports. Administrator Geisel Sanchez agrees to review the reports and to send the signed reports back to the LPA Quiroz via email.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie QuirozTELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2020
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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