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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880576
Report Date: 07/14/2023
Date Signed: 07/14/2023 11:08:06 AM

Document Has Been Signed on 07/14/2023 11:08 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:DESERT SERENITY ADULT RESIDENTIAL FACILITY, LLCFACILITY NUMBER:
331880576
ADMINISTRATOR:SPEDALIERE, JOSEPHFACILITY TYPE:
735
ADDRESS:68340 ENCINITAS RDTELEPHONE:
(760) 377-9002
CITY:CATHEDRAL CITYSTATE: CAZIP CODE:
92234
CAPACITY: 4CENSUS: 4DATE:
07/14/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Diana TIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA), Sara Martinez, arrived unannounced at the facility to conduct a case management visit to address the one (1) Special Incident Reports received for client # 1(C1) behavior. LPA met with administrator Diana Gatz and Licensee Joseph Spedaliere, who was informed of the purpose of the visit.

The Department received one (1) Special Incident Reports (SIR) on 06/08/2023 regarding C1 and her self harm behavior. C1 had cut herself with a eyebrow shaver on 06/06/2023 due to an emotional behavior outburst. SIR details that C1 has tendencies to perform self harming behaviors but when staff is made aware they redirect and help C1 calm down. C1 refused to go to the hospital but first aid was still given by staff.

LPA Martinez interviewed staff and clients, and collected pertinent documents.

Based on observation, interviews, and record review from today’s visit, no information was received by the LPA to indicate there was any lack of care and/or supervision. No citations have been issued at this time. This report was reviewed with and a copy was provided to adminstrator Diana Gatz..
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Sara Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 07/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/14/2023
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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