<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005582
Report Date: 12/27/2023
Date Signed: 12/27/2023 11:43:46 AM

Substantiated


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
12/19/2023 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20231219231542
FACILITY NAME:SERENE BEHAVIORAL HEALTHFACILITY NUMBER:
306005582
ADMINISTRATOR:KARIMKHANI, VALEH DRFACILITY TYPE:
772
ADDRESS:31471 PASEO DURANTELEPHONE:
(714) 656-8296
CITY:SAN JUAN CAPISTRANOSTATE: CAZIP CODE:
92675
CAPACITY:6CENSUS: 4DATE:
12/27/2023
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Jared HudsonTIME COMPLETED:
12:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not reveal the facility license number in a advertisement.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required 10-day visit to begin the investigation into the allegation listed above. LPA met with staff and explained the reason for the visit. LPA and staff toured the facility. The investigation into the allegation, staff did not reveal the facility license number in a advertisement, revealed the following. A review of the website;
https://serenebh.com, shows the website does not list the State of California Department of Social Services and does not list the license number of the facility. LPA confirmed with the staff that the website is the website for the Licensee and the facility. Based on information gathered, the preponderance of evidence standard has been met, therefore, the allegation is found to be substantiated. Violations are being cited per California Code of Regulations, Title 22, Division 6, Chapter 2. An exit interview was conducted and a copy of this report along with citation and Appeal Rights (LIC 9058 01/16) was provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 12/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 22-AS-20231219231542
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 BEHAVIORAL HEALTH
FACILITY NUMBER: 306005582
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/04/2024
Section Cited
CCR
81011(a)
1
2
3
4
5
6
7
Licensees shall reveal each facility license number in all advertisements in accordance with Health and Safety Code section 1514. This requirement was not met as evidenced by,
1
2
3
4
5
6
7
Licensee states the website will be updated to list the State of California Department of Social Services and the facility number as listed on the facility license. Licensee to forward proof of correction to LPA by 1/04/2024.
8
9
10
11
12
13
14
A review of the website, https://serenebh.com/, shows the facility license number is not listed on the website. This poses a potential health and safety risk to clients and prospective clients.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 12/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2