486803640-5-12-2026-21-AS-VBEI-DUARSF-20260521131638

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803640
Report Date: 05/12/2026
Date Signed: 05/12/2026 01:06:45 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/09/2026 and conducted by Evaluator Ali Deniz

COMPLAINT CONTROL NUMBER: 21-AS-20260209111257

FACILITY NAME:	SERENITY CARE MANOR		FACILITY NUMBER:	486803640
ADMINISTRATOR:	SALAS, EMMANUEL PATRICIO		FACILITY TYPE:	740
ADDRESS:	1833 KOLOB DRIVE		TELEPHONE:	(707) 389-4092
CITY:	FAIRFIELD	STATE: CA	ZIP CODE:	94534
CAPACITY:	6	CENSUS: 5	DATE:	05/12/2026
		UNANNOUNCED	TIME BEGAN:	09:27 AM
MET WITH:	Licensee/Administrator, Emmanuel Salas		TIME COMPLETED:	01:25 PM

ALLEGATION(S):

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Residents in care sustained falls due to neglect/lack of supervision.

INVESTIGATION FINDINGS:

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At approximately 09:30 AM, Licensing Program Analyst (LPA) Ali Deniz arrived unannounced to deliver findings for a complaint investigation regarding the above allegation and met with Licensee/Administrator, Emmanuel Salas.

During the course of the investigation, the Department conducted interviews, reviewed documents, and made observations. The following allegations were investigated: “Residents in care sustained falls due to neglect/lack of supervision”.
The complaint alleged that Resident 1 (R1) experienced multiple falls while in care, resulting in bruising to the back, buttocks, neck, and under the left eye. Additional concerns were reported regarding R1’s safety and supervision needs due to R1’s history of falls, gait instability, and lack of coordination. Interviews conducted during the investigation revealed that R1 is prescribed blood thinner medication and bruises easily. R1’s family member acknowledged awareness of R1’s medical condition and confirmed that R1 is considered an extreme fall risk due to impaired gait and coordination difficulties.
Continued on LIC9099-C page...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Ali Deniz
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 21-AS-20260209111257

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: SERENITY CARE MANOR	FACILITY NUMBER: 486803640
	VISIT DATE: 05/12/2026

NARRATIVE

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Continued from LIC90999 page...

The complainant further reported that R1 does not exhibit aggressive behaviors. Per staff interviews, R1 exhibits behaviors that contribute to bruising due to poor coordination and mobility challenges. Staff further stated that when an increase in falls was observed, the facility contacted R1’s physician to address R1’s changing care needs and obtain further medical guidance.

LPA reviewed facility records and physician documentation provided by the facility. Records indicated that R1 has thrombocytopenia, a platelet insufficiency condition that may contribute to increased bruising and bleeding, and a history of transfusions related to this condition.

Although R1 experienced bruising and has a documented history of falls, interviews conducted, and records reviewed did not provide sufficient evidence to support that the falls occurred as a result of neglect or lack of supervision by facility staff. Information obtained during the investigation indicated that R1’s medical conditions, use of blood thinners, impaired coordination, and thrombocytopenia likely contributed to the bruising observed.

Based on interviews conducted, observations made, and records reviewed, there was insufficient evidence to determine that facility staff neglected R1 or failed to provide appropriate supervision. Therefore, the allegation is Unsubstantiated.

A finding that the complaint allegation is UNSUBSTANTIATED means that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

Exit interview conducted. Copy of report discussed and provided to Licensee/Administrator. Signature on form confirms receipt of documents.

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Ali Deniz
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2026

LIC9099 (FAS) - (06/04)

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