<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700592
Report Date: 09/21/2022
Date Signed: 09/21/2022 03:37:41 PM


Document Has Been Signed on 09/21/2022 03:37 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:SERENITY HOME @ MCKINLEYFACILITY NUMBER:
392700592
ADMINISTRATOR:ENRIQUEZ, JAMES LUKEFACILITY TYPE:
740
ADDRESS:10350 S. MCKINLEY AVE.TELEPHONE:
(209) 888-4495
CITY:FRENCH CAMPSTATE: CAZIP CODE:
95231
CAPACITY:20CENSUS: 0DATE:
09/21/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:James EnriquezTIME COMPLETED:
03:45 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
On 9/21/22 Licensing Program Analyst (LPA) Maja Jensen arrived at the facility announced at 3pm to close the facility. LPA Jensen met with Administrator James Enriquez.

The facility is being closed due to loss of control of property resulting in a forfeiture of license. LPA Jensen confirmed that the Administrator contacted the property manager via text message and the property manager agreed to meet at the facility to give licensee access so that LPA can inspect the physical plant. The property manager agreed to be at the facility at approximately 2:20pm. Upon LPA's arrival and during the entire course of the visit no one arrived to allow access to the property. There is a wrought iron fence at the entrance of the driveway which was locked with a chain and pad locked. There were no people visible on the property and no cars on the property. LPA Jensen did not observe any evidence to indicate the property was occupied. LPA Jensen inspected the facility on 9/8/22 and confirmed there were no residents in the facility. LPA Jensen interviewed Administrator James Enriquez who states that Licensee and no one affiliated with Licensee has accepted residents in to the facility.

LPA Jensen was handed the facility license. An exit interview was conducted and a copy of this report and appeal rights were handed to Administrator James Enriquez..
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: 916-639-5584
LICENSING EVALUATOR SIGNATURE:
DATE: 09/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1