374604746-10-31-2024-08-AS-LSIA-DAL9YD-20241031234654

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604746
Report Date: 10/10/2024
Date Signed: 10/31/2024 11:47:32 PM

Document Has Been Signed on 10/31/2024 11:47 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME:	SERENE CARE AT HOME LLC		FACILITY NUMBER:	374604746
ADMINISTRATOR/ DIRECTOR:	MUIA, JANET N		FACILITY TYPE:	735
ADDRESS:	8403 ALADO PLACE		TELEPHONE:	(703) 314-2965
CITY:	EL CAJON	STATE: CA	ZIP CODE:	92021
CAPACITY: 4		CENSUS: 0	DATE:	10/10/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:30 AM
MET WITH:	Licensee Janet Muia and Caregiver Elizabeth Kaguchia		TIME VISIT/ INSPECTION COMPLETED:	04:00 PM

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	Licensing Program Analyst (LPA) Liliana Silveira conducted an announced Pre-Licensing inspection. The inspection included review of Component III, as well as a walk through of the facility’s physical plant for compliance with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code. LPA was greeted at the front entrance by Janet Muia and Elizabeth Kaguchia and was granted entry after identifying themselves and disclosing the purpose of the visit. This is a new facility. The fire clearance was approved on 04/02/2024 and reflected that the facility was approved for 4 clients for an Adult Residential Facility (ARF). All 4 clients must be ambulatory and none can be bedridden. As of today's visit, there were 0 clients in care. The submitted facility sketch was consistent with the current layout of the facility. During today’s visit, LPA, accompanied by Janet and Elizabeth, conducted an overall inspection of the internal and external areas of the facility. The facility was clean, sanitary and in good repair. Required licensing postings were observed in visible areas of the facility. The facility has sufficient space and equipment to facilitate laundry, visitation, meetings, and client activities. All outdoor and indoor pathways were free from obstruction and slip hazards. Smoke and carbon monoxide detectors, emergency lighting, and facility telephone were present and operational. Fire extinguishers were serviced within the last 12 months and affixed with current tags. All toxic substances/poisons, chemicals were stored in a locked area inaccessible to clients. Fireplaces, and/or open-faced heaters were inaccessible to clients. Client bedrooms allowed for easy passage with no obstruction and contained the required furnishings. Each window had a screen which was in good condition. The facility has all the required furnishings, linens and personal hygiene items. Client bedrooms allowed for easy passage with no obstruction and contained the required furnishings. (CONTINUED ON LIC 809C)

SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Liliana Silveira
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: SERENE CARE AT HOME LLC	FACILITY NUMBER: 374604746
	VISIT DATE: 10/10/2024

NARRATIVE

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There are 2 bathrooms for clients to use. Bathrooms are equipped with non-skid mats or stickers.
Toilets, sinks, and showers were in working order. The facility’s ambient internal temperature was compliant at 76 degrees F. There were 2 client bathrooms that measured hot water at the following temperatures: bathroom #1 119.8 F, bathroom #2 at 118.9 F.

The facility kitchen was stocked with appropriate cooking items. The facility has locked areas for storage of sharp objects- knives were locked in a secure cabinet which is inaccessible to clients. A seven (7) day supply of non-perishable and two (2) day supply of perishable food items were present. Medications were secured in a locked cabinet which is inaccessible to clients. A first aid kit and manual were present and located in medicine cabinet. Client and staff files were also in a locked cabinet.

The facility has a pool with no water, with a locked fence 5 feet high. Per Janet Muia, no firearms or ammunition are or will be stored on the facility premise.

LPA discussed continuing operation requirements, record keeping, reporting requirements and physical plant compliance with the applicant. The items reviewed were complaint with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code.

The Pre-Licensing and Component III was completed during today’s visit. The applicant was advised that the facility is ready for licensure, pending management final review and approval.

An exit interview was conducted with applicant Janet Muia, to whom a copy of this report and Licensee Appeal Rights (LIC 9058 01/16) were provided at the conclusion of the visit. The signature below confirms receipt of these documents.

NOTE: LPA left the facility for a 1 hour lunch break and returned to the facility to finish the inspection.

SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Liliana Silveira
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024

LIC809 (FAS) - (06/04)

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