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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361880775
Report Date: 07/31/2025
Date Signed: 07/31/2025 01:47:07 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
07/30/2024 and conducted by Evaluator Mary Rico
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240730115526
FACILITY NAME:SERENITY ADULT CARE HOMES IVFACILITY NUMBER:
361880775
ADMINISTRATOR:BOYCE, DARLEENEFACILITY TYPE:
735
ADDRESS:11542 AUTUMN STREETTELEPHONE:
(760) 523-1108
CITY:ADELANTOSTATE: CAZIP CODE:
92301
CAPACITY:4CENSUS: 3DATE:
07/31/2025
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Administrator- Latanya Clay TIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff refused to accept client at the facility after being discharged from the hospital.
Staff do not adequately supervise client while in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to investigate and deliver findings on the allegations listed above. LPA met with Administrator Latanya Clay and explained the purpose of the visit. The investigation consisted of staff interviews, client interviews and record reviews.

For the allegation, Staff refused to accept client at the facility after being discharged from the hospital.
During staff interviews, 2 out of the 3 staff stated that C1 was returned to the facility. LPA reviewed facility documents and observed C1 was discharged from the hospital and had returned to the facility.

For the allegation, Staff do not adequately supervise client while in care. During staff interviews, 3 out of the 3 staff stated they provide supervision to all clients. In addition, 3 out of the 3 staff stated they have not left clients alone. During clients’ interviews, 3 out of the 3 clients stated staff provided supervision.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 56-AS-20240730115526
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: SERENITY ADULT CARE HOMES IV
FACILITY NUMBER: 361880775
VISIT DATE: 07/31/2025
NARRATIVE
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 Based on the evidence found during the investigation, the two (2) allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) was discussed and provided to the Administrator Latanya Clay .
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2