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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392701610
Report Date: 07/09/2026
Date Signed: 07/10/2026 11:36:36 AM

Unsubstantiated


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: 2DATE:
07/09/2026
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Luz GaribayTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Staff did not ensure that medication was inaccessible to residents
Licensee is not following reporting requirements
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA'S ) Melina Oropeza and Kesha Lewis arrived unannounced to continue complaint investigation regarding the allegations noted above. LPA'S met with the administrator, Luz Garibay LPA’s explained the purpose of the visit.

Staff did not ensure that medication was inaccessible to residents. LPA observed medications properly stored in a locked and secured area inaccessible to residents. The medication storage key was maintained by administrator and inaccessible to residents. LPA observed administrator access the locked medication closet, re-secure the area, pour medication, and administer medication to a resident.

Licensee is not following reporting requirements. Record review revealed no evidence that the licensee failed to follow reporting requirements. Incident occurred on 04/06/26 and administrator reported to CCL on 04/08/26. Incident was reported on time to the appropriate agencies.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Melina Oropeza
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2026
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 2
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: 07/09/2026
NARRATIVE
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Based on observations and record review, the allegations are UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations occurred.

Exit interview was conducted and a copy of the report was given the administrator, Luz Garibay. No citations were issued per Title 22 regulations.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Melina Oropeza
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2