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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 365530162
Report Date: 01/21/2026
Date Signed: 01/21/2026 11:58:17 AM

Substantiated


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
01/15/2026 and conducted by Evaluator Paola Guerrero
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20260115093840
FACILITY NAME:FOOTHILL SERENITY LIVINGFACILITY NUMBER:
365530162
ADMINISTRATOR:GUEVARRA, MARYDESFACILITY TYPE:
735
ADDRESS:8024 REDWOOD AVETELEPHONE:
(909) 371-3967
CITY:FONTANASTATE: CAZIP CODE:
92336
CAPACITY:32CENSUS: 28DATE:
01/21/2026
UNANNOUNCEDTIME BEGAN:
09:43 AM
MET WITH:Rachelle Laureta- CaregiverTIME COMPLETED:
12:10 PM
ALLEGATION(S):
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Staff are not properly addressing pests in the facility
Staff are not ensuring that faucets used by residents for personal care deliver hot water
Staff do not ensure facility is maintained clean
Staff do not follow proper food services sanitation practices to protect food from contamination
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Paola Guerrero arrived at the facility to deliver investigative findings. LPA met with Facility Caregiver Rachelle Laureta and explained the purpose of the visit regarding the allegations listed above.

First allegation: Staff are not properly addressing pests in the facility. Regarding the allegation stated above, LPAs Guerrero and Singh conducted a walkthrough of the facility while inspecting facilities kitchen LPAs observed cockroaches to be on the serving counter where food is provided and served to residents. In addition, LPAs also observed cockroaches to be on the seals of the refrigerator located outside the kitchen near the serving window. LPAs conducted an interview with S#1 regarding the allegation stated above S#1 informed LPAs that facility maintenance sprays the facility however, facility does not have a contract with any pest control company to treat the facility professionally.

Second allegation: Staff are not ensuring that faucets used by residents for personal care deliver hot water. Regarding the allegation stated above, LPAs conducted a walkthrough of the facility during the
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2026
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 4
Control Number 56-AS-20260115093840
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: FOOTHILL SERENITY LIVING
FACILITY NUMBER: 365530162
VISIT DATE: 01/21/2026
NARRATIVE
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walkthrough LPAs inspected four bathrooms during the inspection LPAs discovered that four out of four bathrooms are not delivering hot water. According to Title 22 hot must be in the range of 105 F /120 F, facility was below the 105 F range. In addition, during the inspection LPAs discovered sink faucets and showerheads to be in despair. During the inspection LPAs also discovered that the bathroom shower that serves room 15 & 16 was not delivering water.

Third allegation: Staff do not ensure facility is maintained clean. Regarding the allegation stated above, LPAs conducted a walkthrough of the interior of the facility, during the inspection LPAs discovered facility floor to be sticky. In addition, LPAs observed facility flooring to be in despair. Furthermore, LPAs observed graffiti throughout facility walls and in resident’s rooms. During the walkthrough LPAs discovered foul odor throughout the facility and in residents’ rooms. In addition, LPAs observed that four restrooms to be dirty and unsanitary.

Fourth allegation: Staff do not follow proper food services sanitation practices to protect food from contamination. Regarding the allegation, LPAs conducted a walkthrough of the facility kitchen during the walkthrough LPAs observed kitchen to be at standard. However, during the walkthrough LPAs observed cockroaches to be on the serving counter where food is provided and served to residents. Based on the evidence gathered during the investigation, the above allegations are Substantiated. A finding that the complaint is Substantiated means that the findings are valid because the preponderance of the evidence standard has been met. Title 22 regulations Maintenance and Operation 87303 (a)(1), Buildings and Grounds 85087, Personal Rights of Residents in All Facilities 87411 (a) (2) & (3), Buildings and Grounds 85087 (2) from division 6, chapter, article 6, is, being cited on the attached LIC 9099 D.

An exit interview was conducted where this report, appeal rights, and LIC9099-D was discussed, and a copy of the report was provided to Facility Caregiver Rachelle Laureta at the conclusion of the visit.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 56-AS-20260115093840
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: FOOTHILL SERENITY LIVING
FACILITY NUMBER: 365530162
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/21/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/13/2026
Section Cited
CCR
87468.1(a)(2)(3)
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Personal Rights of Residents in All Facilities 87468.1...(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: ...(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment....(3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination.

This requirement is not met as evidence by:

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Licensee has agreed to read over the Personal Rights regulation and provide training to all staff regarding Personal Rights. The Licensee will contract a pest control agency for the elimination of roaches. The Licensee will provide LPA with a copy of training along with a copy of invoice for pest control addressing roaches. By POC 2/13/2026
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Based on observation the licensee did not ensure that the facility is maintained free from insects for 28 out of 28 residents, which poses an immediate health, safety, or personal rights risk for person's in care.
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Type B
02/13/2026
Section Cited
CCR
85087
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Buildings and Grounds 85087 Hot water temperature must be between 105 & 120 degrees F.

This requirement is not met as evidence by:
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Based on observation the licensee did not ensure hot water temperature to be between 105 & 120 degrees F, for four out of four residents, which poses an immediate health, safety, or personal rights risk for person's in care.
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Licensee has agreed to read over the regulation and provide training to all staff regarding Buildings and Grounds. The Licensee shall contract plumbing services to address hot water. Licensee will provide LPA with a copy of training along with a copy of invoice l addressing hot water. By POC 2/13/2026.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 56-AS-20260115093840
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: FOOTHILL SERENITY LIVING
FACILITY NUMBER: 365530162
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/21/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/13/2026
Section Cited
CCR
87303(a)
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Maintenance and Operation 87303...(a) The facility shall be clean, safe, sanitary and in good repair at all times... Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.

This requirement is not met as evidence by:
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The Licensee has agreed to read over the Personal Rights regulation and provide training to all staff regarding Personal Rights. The Licensee will ensure too deep clean the facility and bring the facility into a clean condition. The Licensee will provide LPA with a copy of training along with pictures addressing all concerns about the violations pertaining to the Maintenance and Operation of the facility. By POC 2/13/2026
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Based on observation the licensee did not ensure that the facility clean, safe, sanitary and in good repair at all times for 28 out of 28 residents, which poses an immediate health, safety, or personal rights risk for person's in care.
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Type B
02/13/2026
Section Cited
CCR
85087(2)
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Buildings and Grounds 85087 (2) Environmental cleaning and disinfection activities shall be performed following the manufacturers' instructions for proper use of the cleaning and disinfecting products. These activities shall be completed, at a minimum, as follows: (A) Surfaces such as floors, chairs, toilets, sinks, counters and tabletops shall be cleaned and disinfected on a regular basis to ensure they are safe and sanitary. These surfaces shall also be disinfected when these surfaces are contaminated and visibly soiled with blood or body fluids or other potentially infectious material.

This requirement is not met as evidence by:
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Licensee has agreed to read over the Buildings and Grounds regulation and provide training to all staff regarding the regulation and maintaining the facility clean and sanitary. Licensee will provide LPA with a copy of training addressing meal preparation concerns. By POC 2/13/2026
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Based on observation the licensee did not ensure that the facility clean and sanitary for 28 out of 28 residents, which poses an immediate health, safety, or personal rights risk for person's in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4