306006328-1-23-2026-22-AS-AORZ-DQU27E-20260130160837

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006328
Report Date: 01/23/2026
Date Signed: 01/23/2026 04:12:13 PM

Unsubstantiated

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
01/16/2026 and conducted by Evaluator Andrea Mendivil

COMPLAINT CONTROL NUMBER: 22-AS-20260116134545

FACILITY NAME:	SERENITY CARE HOME III		FACILITY NUMBER:	306006328
ADMINISTRATOR:	SALCEDO, MIRIAM		FACILITY TYPE:	735
ADDRESS:	1462 KENNETH DRIVE		TELEPHONE:	(949) 346-6010
CITY:	TUSTIN	STATE: CA	ZIP CODE:	92780
CAPACITY:	4	CENSUS: 2	DATE:	01/23/2026
		UNANNOUNCED	TIME BEGAN:	01:31 PM
MET WITH:	Carlos Vargas- Administrator		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility has failed to provide the client their P&I funds since August 2025

INVESTIGATION FINDINGS:

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On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct a complaint investigation. LPA was greeted and granted entry into the facility by staff and explained the reason for the visit.

The Department received a complaint on 01/16/2026 and LPA Mendivil conducted the 10 day visit on 01/23/2026. LPA Mendivil interviewed staff and client and obtained copies of pertinent documents such as emergency information and Individual Program Plan (IPP) for client 1 (C1). Regarding the allegation Facility has failed to provide the client their P&I funds since August 2025 the invesitgation revealed the following:

It was alleged the facility has failed to provide Personal and Incidentals (P&I) funds to C1 since August 2025. Per interviews with Licensee Miriam Salcedo it was reported that C1 elected to use their Personal and Incidental funds to cover their portion of the rent. Licensee stated due to C1's full time employment Regional Center of Orange County concluded C1's share to be $681.17.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2026

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-20260116134545

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: SERENITY CARE HOME III	FACILITY NUMBER: 306006328
	VISIT DATE: 01/23/2026

NARRATIVE

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Per Licensee she deducted C1's rent monthly starting in August 2025. Licensee stated C1 had requested funds prior to August 2025 and she provided P&I funds to the client. Licensee reported they would not deny a client access to their P&I funds. LPA Mendivil interviewed three separate witnesses who all provide conflicting information whether C1 approved their P&I funds to be used for their share of rent. Per interviews with 1 out of 2 clients they were given their P&I when requested.

Therefore based on the preponderance of evidence through interviews and records reviewed the allegation Facility has failed to provide the client their P&I funds since August 2025 is determined to be UNSUBSTANTIATED, meaning that although the allegation may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violation occurred.

No deficiencies cited.
An exit interview was conducted and a copy of this report and confidential names list was provided

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2026

LIC9099 (FAS) - (06/04)

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