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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202729
Report Date: 11/02/2023
Date Signed: 11/02/2023 12:14:56 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/24/2023 and conducted by Evaluator Christine Dolores
COMPLAINT CONTROL NUMBER: 26-AS-20231024135721
FACILITY NAME:SERENITY HOMEFACILITY NUMBER:
435202729
ADMINISTRATOR:MURILLO, JENNIFERFACILITY TYPE:
737
ADDRESS:17390 SERENE DRIVETELEPHONE:
(831) 818-7981
CITY:MORGAN HILLSTATE: CAZIP CODE:
95037
CAPACITY:4CENSUS: 1DATE:
11/02/2023
UNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Jennifer Murillo TIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Staff withholding resident's P&I money
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to open the intial complaint investigation. LPA met with Administrator (ADM), Jennifer Murillo.

On 10/24/2023, the Department received a complaint alleging facility staff are withholding resident's P&I money. On 11/02/2023, the intial complaint investigation was conducted.

The following documents were obtained for this investigation to include R1 - R3's record of client's/resident's safeguarded cash resources form from September - October 2023, physician's report, and Individual Program Plan (IPP).

During visit, LPA counted 3 out of 3 residents (R1 - R3) P&I money with staff (S1) and (S2). 3 out of 3 residents P&I money were observed complete with no shortage of money. SEE LIC9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023
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 26-AS-20231024135721
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME: SERENITY HOME
FACILITY NUMBER: 435202729
VISIT DATE: 11/02/2023
NARRATIVE
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Based on record review of the client's/resident's safeguarded cash resources form, LPA observed R3 received their P&I money on 10/16/2023 and staff deposited the money after 10/18/2023.

Based on interview with the ADM, ADM or the designated ADM are the only persons in charge of depositing the residents P&I money once received. ADM states there can be a delay in depositing the resident's P&I money because their money is first sent to their corporate office in Aptos, then sent to the facility. ADM then is responsible to cash the checks at the bank. ADM states to deposit the residents P&I money based on ADM's availability.

The review of R1 - R3's record of client's/resident's safeguarded cash resources form reflects the amount of money in their P&I binder that is safeguarded by the facility.

The Department has investigated the above allegation. Based on record review, interview, and observation the above allegation is unsubstantiated. An unsubstantiated finding indicates that although the allegation may have happened and/or is valid there was not a preponderance of evidence to prove the alleged violation did or did not occur.

No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Administrator, Jennifer Murillo and a copy of the report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2