306005410-5-10-2023-22-AS-SSAS-CRV2SW-20230515173949

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005410
Report Date: 05/10/2023
Date Signed: 05/10/2023 02:32:17 PM

Unfounded

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
05/01/2023 and conducted by Evaluator Jerome Haley

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230501101609

FACILITY NAME:	SERENTO ROSA		FACILITY NUMBER:	306005410
ADMINISTRATOR:	SHANNON HUNDLEY		FACILITY TYPE:	741
ADDRESS:	17803 IMPERIAL HIGHWAY		TELEPHONE:	(714) 777-9666
CITY:	YORBA LINDA	STATE: CA	ZIP CODE:	92886
CAPACITY:	135	CENSUS: 41	DATE:	05/10/2023
		UNANNOUNCED	TIME BEGAN:	01:41 PM
MET WITH:	Hrag Bekerian - Executive Director		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff do not allow residents reasonable access to a telephone

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jerome Haley made unannouced visit to intiatate the investigation into the complaint received against this facility on May 1, 2023. LPA Haley was allowed into the facility, and explaind the reason for the visit upon entry. LPA Haley discussed the complaint allegation with Senior Executive Director (ED) Hrag Bekerian.

Inbetween resident and staff interviews, LPA Haley took a tour of the interior of the facility. Residents were observed in the dining room eating lunch, some residents were observed getting ready for bingo, and other residnets were in their rooms. Kitchen staff was observed in the kitchen cleaning dishes and preparing dinner.

During the visit LPA Haley interviewed ED Bakerian, 2 facility staff members, 3 facility residents, and 1 witness during the visit. 1 resident refused to be interviewed.
Continued on LIC9099C

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome Haley	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

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-20230501101609

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: SERENTO ROSA	FACILITY NUMBER: 306005410
	VISIT DATE: 05/10/2023

NARRATIVE

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Regarding the allegation, “Staff do not allow residents reasonable access to a telephone": The investigation revealed the following:

During the initial complaint visit LPA Haley interviewed 3 facility staff (including ED Bekerian), 3 residents, and 1 witness. All the staff members and residents interviewed denied this allegation. The witness interviewed did not provide any information or details to support this allegation.

LPA Haley was provided relevant documentation during the visit.

Based on the information gathered during the investigation, observation, and review of all documents obtained, the following allegation: Staff do not allow residents reasonable access to a telephone, is deemed Unfounded, meaning the allegation is false, could not have happened and/or is without a reasonable basis.

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

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome Haley	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

LIC9099 (FAS) - (06/04)

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