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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 576804274
Report Date: 01/23/2026
Date Signed: 01/23/2026 12:42:18 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
10/14/2025 and conducted by Evaluator Jill Nakagawa
COMPLAINT CONTROL NUMBER: 21-AS-20251014084427
FACILITY NAME:SERENITY NOW-SALEMFACILITY NUMBER:
576804274
ADMINISTRATOR:ATILANO, QUEENIE MFACILITY TYPE:
772
ADDRESS:2927, 2929, 2931 SALEM AVETELEPHONE:
(916) 287-7045
CITY:DAVISSTATE: CAZIP CODE:
95616
CAPACITY:6CENSUS: 0DATE:
01/23/2026
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Queenie Atilano, Licensee/AdministratorTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Unqualified staff is administering medication to clients
Staff left clients unattended

INVESTIGATION FINDINGS:
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On January 23, 2026 LPA Nakagawa arrived unannounced to conclude the complaint investigation and deliver findings. LPA discussed with Administrator/Licensee Queenie Atilano.

The complaint alleges that Unqualified staff are administering medication to clients. The reporting party stated staff passing medications are not licensed to do so. LPA requested documentation of staff training and staff schedules on multiple occasions. On 10/21/2025 Licensee/Administrator stated that house manager Staff (S1) failed to provide the requested records to Administrator/Licensee. Administrator/Licensee is unable to provide the requested records. On 12/19/2025 LPA requested training documents again, but they were not submitted. Due to a lack of training records verifying staff were properly trained the allegation that Unqualified staff are administering medication to clients is SUBSTANTIATED. (See 9099-D).
Continued on 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2026
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 21-AS-20251014084427
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: SERENITY NOW-SALEM
FACILITY NUMBER: 576804274
VISIT DATE: 01/23/2026
NARRATIVE
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Continued from 9099.....

The complaint alleges that Staff left clients unattended. The reporting party stated there is no staff at night. LPA requested staff schedules and timecards on multiple occasions, but they were never received. Based on staff schedules and timecard punches not being received as requested there is no evidence provided to dispute the allegations that Staff left clients unattended therefore the allegation is SUBSTANTIATED. (See 9099-D for Deficiencies).

Civil penalty issued under Title 22 Regulation 81078(a) for a total of $500 due to lack of care and supervision.



Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 21-AS-20251014084427
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: SERENITY NOW-SALEM
FACILITY NUMBER: 576804274
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/23/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/23/2026
Section Cited
CCR
81065(f)(4)
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81065 Personnel Requirements(f)All personnel shall be given on-the job training.....performance.(4) Assistance with prescribed medications which are self-administered.
This requirement is not met as evidenced by:
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POC Licensee will provide a plan to have personnel records for all current personnel, including training records to CCL by 1/26/26, prior to acceptance of new clients.
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Based on lack of personnel training records there is no evidence that staff received the training necessary to safely carry out their duties which poses an immediate health and safety risk to persons in care.
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Type A
01/23/2026
Section Cited
CCR
81078(a)
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Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision....to meet client's needs.
This requirement is not met as evidenced by:
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POC Licensee will keep possession of all personnel files including staff schedules and time card records on the premises and submit proof of files being set up on site to CCL by 01/26/2026.
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 Based on Licensee unable to verify staffing at night by providing staff schedules and time clock punches. the licensee did not comply with the section cited above, which poses/posed an immediate health and safety or personal rights risk to persons in care.
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Civil Penalty Assessed for Absence of Supervision.
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: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
10/14/2025 and conducted by Evaluator Jill Nakagawa
COMPLAINT CONTROL NUMBER: 21-AS-20251014084427

FACILITY NAME:SERENITY NOW-SALEMFACILITY NUMBER:
576804274
ADMINISTRATOR:ATILANO, QUEENIE MFACILITY TYPE:
772
ADDRESS:2927, 2929, 2931 SALEM AVETELEPHONE:
(916) 287-7045
CITY:DAVISSTATE: CAZIP CODE:
95616
CAPACITY:6CENSUS: 0DATE:
01/23/2026
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Queenie Atilano, Licensee/AdministratorTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Staff are not meeting clients mental health needs
Staff are not cooking for residents
INVESTIGATION FINDINGS:
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On January 23, 2026 LPA Nakagawa arrived unannounced to conclude the complaint investigation and deliver findings. LPA discussed with Administrator/Licensee Queenie Atilano.

On 10/15/2025 LPA Nakagawa inspected the facility and requested documents regarding the allegations that Staff are not meeting clients' mental health needs and Staff are not cooking for residents. LPA observed a well-stocked refrigerator and food cooking on the stove, being prepared by staff. LPA interviewed House Manager (S1) of the facility who stated S1 and other staff were doing the cooking. LPA also interviewed 3 of 3 clients in residency at the facility, each of whom were very satisfied with the care and treatment they were receiving. 3 of 3 residents in care had no complaints regarding the food service which they stated was prepared by facility staff.

Continued on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 21-AS-20251014084427
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: SERENITY NOW-SALEM
FACILITY NUMBER: 576804274
VISIT DATE: 01/23/2026
NARRATIVE
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Continued from 9099-A

3 of 3 clients stated that they are receiving their therapy sessions and medications as required. 3 of 3 clients stated the staff were good and they were satisfied.

Based on the statements of clients in care and lack of evidence provided by the reporting party to corroborate the allegations there is not a preponderance of evidence to substantiate the above allegations therefore the allegations: Staff are not meeting client’s mental health needs and Staff are not cooking for residents are unsubstantiated.

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5