336425532-2-3-2023-18-AS-JESL-CT2TJH-20230622144623

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336425532
Report Date: 02/03/2023
Date Signed: 02/03/2023 12:06:28 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/22/2022 and conducted by Evaluator Janira Arreola

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20221122172030

FACILITY NAME:	SERENITY HAVEN		FACILITY NUMBER:	336425532
ADMINISTRATOR:	BRANDON T. HARMISON		FACILITY TYPE:	740
ADDRESS:	24300 CANYON LAKE DR. N		TELEPHONE:	(951) 246-9465
CITY:	CANYON LAKE	STATE: CA	ZIP CODE:	92587
CAPACITY:	6	CENSUS: 3	DATE:	02/03/2023
		UNANNOUNCED	TIME BEGAN:	10:55 AM
MET WITH:			TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Dogs are urinating on facility floor

INVESTIGATION FINDINGS:

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Licensing Prgram Analysts (LPAs) Janira Arreola and jaqueline Shaw Ross conducted an unannounced vivist to the facility in order to deliver findings on the allegation listed above. LPAs met with Mary Anne Harmison who was informed of the purp[ose of the vivist.

LPAs conducted interviews and documented observations while at the facility. It was alleged that the facility dog was urinating on the floor of the facility, including the facility restroom. During the time of the visit LPAs did not observe any dog urine on the facility floors or restrooms. LPA observed the staff was conducted cleaning of the floors with a broom and mop, and when interviewed stated that the facility floors are cleaned twice a day. LPA took photos of the facility floor during the visit. LPA Arreola has conducted vivists tot the facility on 1/11/2023, 1/18/2023, and 1/27/2023 and during these ivists did not observed any dog urine on the facility floor. LPA conducted interviews with the facility resident who stated they had not seen any dog urine in their rooms or at the facility. One resident stated that the facility dog "Paris" was urinating on the facility floor but has since been removed from the facility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira Arreola	TELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023

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 18-AS-20221122172030

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: SERENITY HAVEN	FACILITY NUMBER: 336425532
	VISIT DATE: 02/03/2023

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	Based on observation and interviews it was found that the allegation is unsubstantiated. A finding of unsubstantiated means that although the allegation is valid, the preponderance of the evidence standard has not been met. An exit interview was conducted where this report was reviewed and provided to staff, Mary Anne Harmison.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira Arreola	TELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023

LIC9099 (FAS) - (06/04)

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