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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005582
Report Date: 04/30/2024
Date Signed: 04/30/2024 12:31:35 PM

Document Has Been Signed on 04/30/2024 12:31 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:SERENE BEHAVIORAL HEALTHFACILITY NUMBER:
306005582
ADMINISTRATOR/
DIRECTOR:
KARIMKHANI, VALEH DRFACILITY TYPE:
772
ADDRESS:31471 PASEO DURANTELEPHONE:
(714) 656-8296
CITY:SAN JUAN CAPISTRANOSTATE: CAZIP CODE:
92675
CAPACITY: 6CENSUS: 5DATE:
04/30/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:34 AM
MET WITH:Cyndie DunkersonTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA met with Cyndie Dunkerson, Brook Lazaro, Bailey Waln and Thinh Pham and explained the reason for the visit. LPA and staff toured facility. Facility is a two story home with 5 bedrooms upstairs ( 1 bedroom is being used as an office) an office on the first floor, one bedroom downstairs along with a living room, dining room, laundry room and a 3 car attached garage. LPA observed all client bedrooms had the required furnishings. All bathrooms were clean and operational. Hot water in all bathrooms measured 106.7 degrees Fahrenheit. LPA observed all medications are kept locked in the facility office. LPA observed that sharp objects are kept locked in the facility office. Cleaning supplies are kept locked in the garage. The garage is used for storage and kept locked. Smoke detectors/carbon monoxide detectors tested operational. LPA observed the fireplace in the family room is screened. LPA observed the kitchen is clean and organized. LPA observed an emergency evacuation chair mounted on the top of the stairway. LPA and staff toured the backyard. There is a swimming pool surrounded by a fence. The pool gate is locked. Both backyard exit gates are latched and operational. No obstacles or hazards observed inside or outside of the facility. LPA reviewed 2 staff files. No discrepancies observed. LPA reviewed 5 client files, no discrepancies observed. LPA reviewed client medications. No discrepancies observed. LPA inspected the first aid kit. The first aid kit had all the required elements. LPA consulted with staff regarding reporting requirements and Guardian/background clearance requirements. An exit interview was conducted and a copy of the report provided.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE: DATE: 04/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/30/2024
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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