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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392701610
Report Date: 04/21/2026
Date Signed: 04/21/2026 02:02:06 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/13/2026 and conducted by Evaluator Melina Oropeza
COMPLAINT CONTROL NUMBER: 27-AS-20260413132003
FACILITY NAME:SERENITY VILLA LLCFACILITY NUMBER:
392701610
ADMINISTRATOR:GARIBAY, LUZFACILITY TYPE:
740
ADDRESS:1740 POST OAK AVENUETELEPHONE:
(510) 200-2940
CITY:MANTECASTATE: CAZIP CODE:
95336
CAPACITY:6CENSUS: 3DATE:
04/21/2026
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Claudia CastilloTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff left residents unsupervised
Staff did not ensure that residents' incontinence needs were met
Licensee is not following plan of operation
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA'S ) Kesha Lewis and Melina Oropeza arrived unannounced to open a complaint investigation regarding the allegations noted above. LPA'S met with the staff member, Claudia Castillo LPA’s explained the purpose of the visit.

Staff left residents unsupervised based on interviews with licensee and staff along with video survelliance. S1 was seen leaving the facility and was the only one on duty. Therefore, the allegation is SUBSTANTIATED.

Staff did not ensure that residents' incontinence needs were met based on interview with licesnsee. When they arrived at facility residents were soiled.Therefore,the allegation is SUBSTANTIATED.

Licensee is not following plan of operation based on plan of operation, staff member is to be present at all times. Residents are not to be left unsupervised. Therefore, the allegation is SUBSTANTIATED.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Melina Oropeza
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2026
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 5
Control Number 27-AS-20260413132003
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: SERENITY VILLA LLC
FACILITY NUMBER: 392701610
VISIT DATE: 04/21/2026
NARRATIVE
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 It was determine the ponderance of the evidence standard has been met, therefore the above allegations are found to be substantiated. California code of regulations are being cited on LIC 9099-D. Appeals rights have been provided and an exit interview has been conducted to discuss the findings.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Melina Oropeza
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/13/2026 and conducted by Evaluator Melina Oropeza
COMPLAINT CONTROL NUMBER: 27-AS-20260413132003

FACILITY NAME:SERENITY VILLA LLCFACILITY NUMBER:
392701610
ADMINISTRATOR:GARIBAY, LUZFACILITY TYPE:
740
ADDRESS:1740 POST OAK AVENUETELEPHONE:
(510) 200-2940
CITY:MANTECASTATE: CAZIP CODE:
95336
CAPACITY:6CENSUS: 3DATE:
04/21/2026
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Claudia CastilloTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff did not administer residents' medication
Staff did not ensure resident's were provided with adequate meal service
Facility is malodorous
INVESTIGATION FINDINGS:
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Staff did not administer residents' medication based on the interview with the licensee and the MARS for the month of April 2026.

Staff did not ensure resident's were provided with adequate meal service based on video surveillance, the staff member was in the kitchen by to stove. Interviews with clients were not able to be conducted if their breakfasts were served because one has left the facility, one was asleep, and the other one unable to confirm.

Facility is malodorous based on observations during the visit, here was no odor observed. The facility is cleaned and sanitary.

Although the allegations may have happened or is valid, there is not a ponderance of the evidence to prove the allege violations did or did not occur, therefore the allegations are unsubstantiated.
Exit interview was conducted and a copy of the report was given the staff member, Caludia Castillo. No citations were issued per Title 22 regulations.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Melina Oropeza
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 27-AS-20260413132003
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: SERENITY VILLA LLC
FACILITY NUMBER: 392701610
VISIT DATE: 04/21/2026
NARRATIVE
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Staff did not ensure that medication was inaccessible to residents based on observation medication cabinet is locked and medications in the refrigerator is in a locked box.

Licensee is not following reporting requirements based on interview with licensee, they reported the incident to the officer of the day and sent a serious incident report to the department on 04/10/2026.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Melina Oropeza
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 27-AS-20260413132003
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SERENITY VILLA LLC
FACILITY NUMBER: 392701610
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/21/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/22/2026
Section Cited
CCR
87464(f)(1)
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(f) Basic services shall at a minimum include:
87464 (f) (1) Basic services
(f) Basic services shall at a minimum include:
(1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code
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Administrator agrees to conduct basic services training for all staff. Administrator will read the regulation cited and provide LPA Oropeza a letter of acknowledgement that the regulation cited was reviewed.


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Based on observation, file review, and interview with the administrator did not ensure staff provide care and supervision to R1. Leaving reditents R1-R3 at the facility alone.
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Administrator will email documents used for training and sign in sheet by POC Date 04/22/2026 by end of day 5:00pm.
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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: Liza King
LICENSING EVALUATOR NAME: Melina Oropeza
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5