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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005410
Report Date: 09/18/2023
Date Signed: 09/18/2023 12:32:07 PM


Document Has Been Signed on 09/18/2023 12:32 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:SERENTO ROSAFACILITY NUMBER:
306005410
ADMINISTRATOR:HRAG BEKERIANFACILITY TYPE:
741
ADDRESS:17803 IMPERIAL HIGHWAYTELEPHONE:
(714) 777-9666
CITY:YORBA LINDASTATE: CAZIP CODE:
92886
CAPACITY:135CENSUS: 70DATE:
09/18/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Angie PerezTIME COMPLETED:
12:45 PM
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This unannounced Case Management – Incident inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of following up on a self-reported incident report received in the Orange County Regional Office (OCRO) on 09/07/23 regarding an allegation of misconduct involving Resident #1 (R1) and Staff #1 (S1). LPA met with Health Services Director (HSD) Angie Perez and discussed the purpose of the inspection. Administrator (AD) Hrag Bekerian was not present during the inspection.

During today’s inspection, LPA conducted a health and safety check on R1, interviewed 6 residents, 3 staff, and requested and reviewed copies of resident records and staff records. The evidence obtained did not substantiate the allegation.

Based on the information obtained during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:
DATE: 09/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/18/2023
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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