547209023-4-17-2026-24-AS-AWAN-DUFTGW-20260526144349

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 547209023
Report Date: 04/16/2026
Date Signed: 04/17/2026 09:12:08 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/04/2025 and conducted by Evaluator Les Xiong

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20251104154137

FACILITY NAME:	SERENITY SENIOR CARE		FACILITY NUMBER:	547209023
ADMINISTRATOR:	ESQUIVEL, BRIANNA		FACILITY TYPE:	740
ADDRESS:	164 EAST YATES		TELEPHONE:	(559) 719-7510
CITY:	PORTERVILLE	STATE: CA	ZIP CODE:	93257
CAPACITY:	6	CENSUS:	DATE:	04/16/2026
		UNANNOUNCED	TIME BEGAN:	12:31 PM
MET WITH:	Brianna Esquivel		TIME COMPLETED:	02:17 PM

ALLEGATION(S):

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Staff did not distribute resident's medication as prescribed

INVESTIGATION FINDINGS:

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On 04/16/26, Licensing Program Analyst (LPA) L. Xiong arrived unannounced to deliver findings on the above allegations.
During the course of this investigation, LPA conducted interviews and reviewed records.
Upon review of facility records, it was found that on 10/09/2025, facility staff administered 0.5mg lorazepam to R1 at 8:36AM and again at 12:04(PM). Additionally, on 10/10/2025, facility staff administered the same medication to R1 at 7:20AM and 12:28PM. Records revealed that the medication should be administered every 6 hours as needed.
Based on record review, the preponderance of evidence standard has been met, therefore the allegations: Staff did not distribute resident's medication as prescribed is found to be SUBSTANTIATED.
A deficiency is being issued in accordance with California Code of Regulations, Title 22, Division 6 on the attached 9099D.
An exit interview was conducted and a plan of correction was reviewed and developed with Brianna Esquivel. A copy of this report and appeal rights were provided to Brianna Esquivel.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Alexandria Walton
LICENSING EVALUATOR NAME: Les Xiong
LICENSING EVALUATOR SIGNATURE:	DATE: 04/16/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2026

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 24-AS-20251104154137

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: SERENITY SENIOR CARE	FACILITY NUMBER: 547209023
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/16/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 04/23/2026 Section Cited CCR 87465(a)	1 2 3 4 5 6 7	87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care …shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed… this requirement was not met as evidenced by: Based on records review, the Licensee did not comply with section 87465(a)(4) when facility staff administered medication to R1 at 8:36AM and again at 12:04PM on 10/09/25 and at 7:20AM and 12:28PM when the medication was prescribed to be given every 6 hours, which is an immediate health and safety risk to residents in care.	1 2 3 4 5 6 7	Per licensee, will conduct an in-service training on incidental medical training by the POC date and submit the training document to CCL.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Alexandria Walton
LICENSING EVALUATOR NAME: Les Xiong
LICENSING EVALUATOR SIGNATURE:	DATE: 04/16/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2026

LIC9099 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/04/2025 and conducted by Evaluator Les Xiong

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20251104154137

FACILITY NAME:	SERENITY SENIOR CARE		FACILITY NUMBER:	547209023
ADMINISTRATOR:	ESQUIVEL, BRIANNA		FACILITY TYPE:	740
ADDRESS:	164 EAST YATES		TELEPHONE:	(559) 719-7510
CITY:	PORTERVILLE	STATE: CA	ZIP CODE:	93257
CAPACITY:	6	CENSUS:	DATE:	04/16/2026
		UNANNOUNCED	TIME BEGAN:	12:31 PM
MET WITH:	Brianna Esquivel		TIME COMPLETED:	02:17 PM

ALLEGATION(S):

1
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3
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5
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7
8
9

Staff did not assist resident with obtaining medical care
Staff did not report incident to responsible party
Staff did not assist resident with toileting
Staff do not ensure that residents' dietary needs are met
Licensee inappropriately speaks to residents
Licensee does not ensure that staff have required training

INVESTIGATION FINDINGS:

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2
3
4
5
6
7
8
9
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12
13

On 4/16/26, Licensing Program Analyst (LPA) L. Xiong arrived unannounced to deliver findings on the above allegations.
During the course of this investigation, LPA conducted interviews and reviewed records.
Based on interviews conducted, R1 also received hospice services which assisted with providing R1 medical care. Administrator stated that all incidents are reported to the appropriate parties. A review of the facility file revealed that the Administrator has reported incidents to the Fresno CCL office. Interviews revealed that facility staff assisted R1 with personal hygiene and toileting. Consistent statements from interviews revealed that the Administrator purchases groceries for the facility and meals are prepared by facility staff. Interviews also revealed that staff have not spoken inappropriately to residents in care. LPA reviewed staff training and found that staff training is current.
Based on interview, records review, and observations, the allegations: Staff did not assist resident with obtaining medical care; Staff did not report incident to responsible party; Staff did not assist resident with toileting; Staff do not ensure that residents' dietary needs are met; Licensee inappropriately speaks to residents; Licensee does not ensure that staff have required training are found to be UNSUBSTANTIATED. Although the allegations may have happened and/or valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.
No deficiencies issued. Exit interview conducted. A copy of this report was provided to Brianna Esquivel .

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Alexandria Walton
LICENSING EVALUATOR NAME: Les Xiong
LICENSING EVALUATOR SIGNATURE:	DATE: 04/16/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2026

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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