Routine inspection·July 22, 2024

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to A Serene Senior Living. The purpose of today’s visit was to conduct the Annual Required inspection. LPA was allowed entry into the facility and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents, one of which may be bedridden. Facility has an approved hospice waiver for 4 residents and the home currently has 6 residents, with 2 on hospice. Administrators Minerva Sansano and Ray Santianez arrived during the visit. Administrator Ray Santianez has an administrator certificate valid until 08/18/2025. LPA Lyman along with Caregiver Raquel Pamintuan toured the facility at 7:36 AM. LPA toured the physical plant, checked food service, first aid kit and reviewed records. Facility appears to be clean, safe, and sanitary. The home consists of six resident bedrooms, 2 common restrooms, one staff room, living room, dining room, and kitchen. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. LPA observed five residents with a half bed rails. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 106.8 and 107.7 degrees F in all facility bathrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. Auditory exit alarms were operational during today's visit. First aid kit had all the elements including thermometer, tweezers and scissors as well as a first aid manual. LPA observed toxins are secured during today's visit. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Smoke detectors and Carbon Monoxide detectors are hardwired and tested operational during today's visit. Fire extinguisher is fully charged. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and there is ample shaded seating for residents. Exit gates are unlocked and self latching. LPA observed ample emergency food and water supply. LPA reviewed the emergency disaster plan and infection control plan during the visit. Plans are thorough and complete. Facility provided documentation of last fire drill conducted on 04/24/2024. CONT ON LIC809-C DATED 07/21/2024. Facility provides activities in the form of exercise, games and music. At 8:30 AM, LPA reviewed six resident files and five staff files. Resident files contained required documents including admission agreements, physician reports and resident appraisals. Staff files reviewed contained required documentation of medical clearance/ TB, CPR training and criminal record clearance. Three out of five staff files do not have proof of training in the file. At 9:30 AM, LPA reviewed medication storage and administration. Medications are stored in a locked cabinet. Medications are being administered per physician order. LPA observed facility is pre-pouring medications for 48 hours. Based on the observations made during today's visit, the following violations are being cited per California Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted and a copy of this report as well as appeal rights were discussed and provided with facility representative.