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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 195850277
Report Date: 01/11/2024
Date Signed: 01/11/2024 05:57:42 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/10/2024 and conducted by Evaluator Emily Peraldi
COMPLAINT CONTROL NUMBER: 29-AS-20240110160258
FACILITY NAME:BENTLEY HILLSFACILITY NUMBER:
195850277
ADMINISTRATOR:AQUINO, ROBINFACILITY TYPE:
740
ADDRESS:22740 HATTERAS STREETTELEPHONE:
(213) 478-0460
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91367
CAPACITY:6CENSUS: 5DATE:
01/11/2024
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Christian Havsgaard, ApplicantTIME COMPLETED:
06:00 PM
ALLEGATION(S):
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Facility is in violation of fire clearance.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Emily Peraldi, along with Los Angeles City Fire Inspector Linsay Pellegrini conducted an unannounced initial complaint visit to this facility. At 11:05 a.m., the LPA met with Applicant, Christian Havsgaard and explained the reason for the visit. At 4:53 p.m., the LPA and LPM Heffernan spoke with the Licensee Representative Stephany Perez, and Licensee Mona Marasigan Alcaraz over the telephone.

At 11:13 a.m., the LPA and Fire Inspector Pellegrini along with the Applicant conducted a physical plant tour. At 12:20 p.m., the LPA conducted an interview with the Applicant.

Continued on LIC 9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily PeraldiTELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024
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 29-AS-20240110160258
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: BENTLEY HILLS
FACILITY NUMBER: 195850277
VISIT DATE: 01/11/2024
NARRATIVE
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Regarding the allegation: Facility is in violation of fire clearance. During the time of the visit on 01/11/2024, the LPA and the Fire Inspector Pellegrini observed the following: an unpermitted makeshift staff room near the back of the facility. The former garage turned into a living area with a kitchen including a stove and over the range hood and a room without building permits. Doorknobs throughout the facility need adjustments. The magnet hold door to room 4 does not close and latch properly. The applicant explained that he was unaware of the rooms not having a permit and will work with the landlord or the Licensee to either demolish the unpermitted rooms or acquire the correct permits. Based on observations, the preponderance of evidence standard has been met, therefore the above allegation is deemed Substantiated.

Per the California Code of Regulations, Title 22, Division 6, Chapter 8, the following deficiencies were observed and cited during the visit (See 9099-D). Immediate civil penalty of $500 issued.

Exit interview conducted. A copy of the report and appeal rights were provided.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily PeraldiTELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20240110160258
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: BENTLEY HILLS
FACILITY NUMBER: 195850277
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/11/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/12/2024
Section Cited
CCR
87202(a)
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87202(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal...
This requirement is not met as evidenced by:
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The Licensee and applicant agreed to do the following:
- Send a plan within 24 hours on how facility will be in compliance with fire clearance and corrections.
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Based on observation, the licensee did not comply with the section cited above as multiple fire violations were not corrected, which poses an immediate health and safety risk to persons in care.
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Immediate civil penalty of $500 issued.
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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.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily PeraldiTELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024
LIC9099 (FAS) - (06/04)
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