306005294-4-7-2021-22-AS-AORZ-C2BRGQ-20210422130105

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005294
Report Date: 04/07/2021
Date Signed: 04/07/2021 12:48:58 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/03/2020 and conducted by Evaluator Rosie Quiroz

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200603112051

FACILITY NAME:	SERENE SENIOR CARE		FACILITY NUMBER:	306005294
ADMINISTRATOR:	TADEO, CYNTHIA		FACILITY TYPE:	740
ADDRESS:	13092 NEWLAND STREET		TELEPHONE:	(657) 263-4988
CITY:	GARDEN GROVE	STATE: CA	ZIP CODE:	92844
CAPACITY:	6	CENSUS: 4	DATE:	04/07/2021
		UNANNOUNCED	TIME BEGAN:	12:04 PM
MET WITH:	Cynthia Tadeo, Licensee		TIME COMPLETED:	12:46 PM

ALLEGATION(S):

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-Licensee sold license without proper authorization

INVESTIGATION FINDINGS:

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On today's date Licensing Program Analyst (LPA) LPA Rosie Quiroz conducted a telephonic call on this day for the purpose of delivering findings regarding complaint control #22-AS-20200603112051. Today’s visit was conducted via telephone due to COVID-19 precautionary measures.
During the course of this investigation, LPA Quiroz conducted interviews, reviewed documents including but not limited to personnel report (LIC 500), Employee pay stubs, Lease Agreement of property dated 6/16/2020, Management agreement dated 6/15/2020, Administrator Certificate for Geisel Sanchez, Prominent Escrow Services documents, Designation of Responsibility forms, facility roster and copies of the following utility bills: Water, electricity and Gas company.
During the course of the investigation it was concluded that Licensee Cynthia Tadeo decided to sell Serene Senior Care, and had no knowledge of proper protocol to sell facility.

CONTINUED ON NEXT PAGE...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie Quiroz	TELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2021

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 22-AS-20200603112051

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 CARE	FACILITY NUMBER: 306005294
	VISIT DATE: 04/07/2021

NARRATIVE

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LPA Quiroz reviewed Management Agreement dated 6/15/2020. Management Agreement Section (A) states "Parties understand Serene Senior Care LLC is responsible for the daily operations at 13092 Newland St., Garden Grove, CA 92844 under license 306005294 and adhere to all Title 22 Regulations."

Interviews with interviewees concluded Licensee is still actively involved in the operation of the facility until change of ownership is successfully completed and new Licensee obtains licensure to operate Residential Faciltiy for the Elderly. Prospective new owner is currently proceeding with application process and has hired Career Smart Learning to assist with application process.
This agency has investigated the complaint alleging "Licensee sold license without proper authorization,"
We have found that the allegation is deemed UNSUBSTANTIATED; meaning although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

An exit interview was conducted with Licensee Cynthia Tadeo via telephone. The report was sent via email and an electronic email read receipt confirms receiving of the report. Licensee Tadeo agrees to review the report and to send the signed report back to the LPA Quiroz via email.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie Quiroz	TELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2021

LIC9099 (FAS) - (06/04)

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