Facility Evaluation Report

Serenity Home Care LLC, Cypress07/12/2023Licence 306006338

Capacity6
Census4
Date signed07/17/2023 11:52:07 AM
The inspector’s account

COMP II Participants: Annette Winters - CEO/Administrator

On July 12, 2023, Applicant/Administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained.

During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of the

1. Facility operation: License type, client/resident populations, and program

4. Restrictive/Prohibited Health Conditions

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction