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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 335530297
Report Date: 06/03/2026
Date Signed: 06/10/2026 04:54:03 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/15/2026 and conducted by Evaluator Beena Singh
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20260415085224
FACILITY NAME:SERENITY CIRCLE SENIOR LIVINGFACILITY NUMBER:
335530297
ADMINISTRATOR:MCDAVID, DANIELFACILITY TYPE:
740
ADDRESS:10953 CAMPBELL AVE.TELEPHONE:
(323) 767-4482
CITY:RIVERSIDESTATE: CAZIP CODE:
92505
CAPACITY:0CENSUS: 0DATE:
06/03/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Tenant-Melvin RiveraTIME COMPLETED:
12:20 PM
ALLEGATION(S):
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Licensee did not send a copy of the closure plan to the local ombudsman program.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Beena Singh conducted an unannounced visit to investigate and deliver the findings on the allegation listed above. LPA called Licensee/Administrator and they informed LPA Singh that there are no residents living at the property and tenants are renting this property, LPA and explained the purpose of today’s visit. The investigation consisted of LPAs observation, walk through of the property and Administrator and tenant's interview.

LPA Singh conducted a site visit and interviewed Tenant #1, who confirmed that no residents are currently living at the property and that the home is occupied solely by their family. During an exterior perimeter walk-through, the LPA noted a children's trampoline and observed no imminent health or safety hazards. The Administrator-Emmanuel Gamboa, further clarified that the facility located at 10953 Campbell Ave, Riverside, CA, has ceased operations for RCFE purposes and never officially housed any residents. The property is now being utilized as a standard residential rental for long-term tenants unaffiliated with the RCFE or any other business entity.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2026
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 3
Control Number 56-AS-20260415085224
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: SERENITY CIRCLE SENIOR LIVING
FACILITY NUMBER: 335530297
VISIT DATE: 06/03/2026
NARRATIVE
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Licensee/Administrator did not submit an official letter of closure plan to Community care Licensing Department(CCLD)Licensee changed plan of operation of Residential Care Facility for Elderly (RCFE) without notifying CCLD, before renting facility to long-term tenants.

Allegation: Licensee did not send a copy of the closure plan to the Community Care Licensing Department and local ombudsman program is Substantiated.

Substantiated: A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Title 22 regulations, Plan Of Operation 87208 from division 6, chapter,article 6, is being cited on the attached LIC9099 D.

Section 87208- Plan of Operation requires all facilities to maintain a current, written definitive plan of operation, therefore, the allegation is SUBSTANTIATED.


An exit interview was conducted and a copy of this report LIC9099, LIC9099 D, Appeal Rights has been discussed and provided to facility administrator Emmanuel Gamboa.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 56-AS-20260415085224
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: SERENITY CIRCLE SENIOR LIVING
FACILITY NUMBER: 335530297
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/03/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/03/2026
Section Cited
HSC
1569.49
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(a) The licensee shall have and maintain a current, written definitive plan of operation for the facility. The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing so pursuant to Health and Safety Code section 1569.49. The plan and related materials shall be on file in the facility and shall be submitted to the licensing agency with the license application. Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval.
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Licensee/Administrator Emmanuel Gamboa has provided proof of plan of correction by submitting confirmation letter of the closing of the RCFE via email to LPA Singh.
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Based on LPA observations and interviews, the Licensee/administrator did not comply with the section cited above by not providing a copy of the closure plan to the Community Care Licensing Division(CCLD) and local Ombudsman, which poses a health, safety and personal rights risk to persons in care.
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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: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3