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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006315
Report Date: 10/15/2024
Date Signed: 10/15/2024 02:57:57 PM

Document Has Been Signed on 10/15/2024 02:57 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:SERIN HOMESFACILITY NUMBER:
306006315
ADMINISTRATOR/
DIRECTOR:		MENDOZA, ALVINFACILITY TYPE:
735
ADDRESS:2051 W. DOGWOOD AVE.TELEPHONE:
(714) 261-4530
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY: 4CENSUS: 4DATE:
10/15/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:52 PM
MET WITH:Mayela SaMillanTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Lydia Martinez conducted a Case Management visit to the facility to obtain information pertaining to a self reported incident alleging sexual abuse involving Client 1 (C1). The facility submitted the Incident report on 06/21/2024 and again on 10/11/2024. The report indicated that the incident occurred on 06/17/2024.

One of four Clients was present during today's visit. Client in care appeared to be safe; no imminent health/safety concerns were observed. LPA inspected the inside of facility, and living space. Facility appeared to be clean and organized. LPA noted Activity room next to dining room is having electrical work done. LPA inspected outside perimeter of facility, to ensure no health/safety hazards were present. Facility was maintained at a comfortable temperature for the Clients in care. The needs of the Clients in care appeared to be met during LPA's inspection. Client's appeared to be groomed appropriately and no visible injuries noted. LPA inspected facility food supplies, food supplies were observed to be adequate during this inspection.

LPA obtained copies of pertinent documents. Administrator conducted it's own internal investigation into the allegation. According to AD, C1 wanted to hurt self due to alleged abuse. Psychiatrist initiated a 51/50 hold to evaluate C1. C1 later denied the sexual abuse and apologized.

Based on the information obtained during today’s visit, no citations are being issued during today’s visit. An exit interview was conducted, and a copy of this report along with a copy of the LIC 811 was sent to email on file.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Lydia Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/15/2024
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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