195850277-12-18-2024-29-AS-VCOY-DC3LDA-20241218073934

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 195850277
Report Date: 12/17/2024
Date Signed: 12/18/2024 07:40:10 AM

Document Has Been Signed on 12/18/2024 07:40 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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
ADMINISTRATOR/ DIRECTOR:	AQUINO, ROBIN		FACILITY TYPE:	740
ADDRESS:	22740 HATTERAS STREET		TELEPHONE:	(213) 478-0460
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91367
CAPACITY: 0	TOTAL ENROLLED CHILDREN: 0	CENSUS: 6	DATE:	12/17/2024
TYPE OF VISIT:	Case Management - Deficiencies	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:45 AM
MET WITH:	Christian Havsgaard and Vanessa, Administrators for True Living LLC		TIME VISIT/ INSPECTION COMPLETED:	04:45 PM

NARRATIVE

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At 10:45 A.M. Licensing Program Analysts (LPAs) Valeria Conway and Zabel Chochian conducted a Case Management - Deficiencies visit in conjunction with a complaint visit (Complaint Control #29-AS-20240222085310). The purpose of the visit is to issue citations for deficiencies observed during the initial complaint investigation. Upon arrival, LPAs met with Administrator Vanessa Barcela and reason for visit was explained.

On 02/29/2024 LPAs Valeria Conway and Emily Peraldi arrived at the facility to conduct a 10-day initial complaint visit. Administrator to be Vanessa Havsgaard and Applicant, Christian Havsgaard were the only ones present during this visit, as they are in the process of taking over the business and becoming the new owners of the facility, which will soon transition from Bentley Hills to True Living Care LLC. As part of the investigation LPAs requested paperwork including admission agreement for Resident #1 (R1). The requested paperwork was signed between 01/30/2024 and 02/09/2024 and reflected True Living Care LLC as the facility providing services. True Living Care LLC was pending licensure at the time of the visit. The admission agreement used by licensee was not approved by CCL.

Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 809-D.) Administrator was informed that failure to correct the deficiencies may result in civil penalties.

Exit interview conducted, appeal rights discussed, and a copy of this report and appeal rights were provided.

Desaree Perera	TELEPHONE: (818) 596-4347
Valeria Conway	TELEPHONE: (818) 454-0485
	DATE: 12/17/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/18/2024 07:40 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 12/17/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

87208 Plan of Operation (a)Each facility shall have and maintain a current, written definitive plan of operation... Any significant changes... which would affect the services to residents shall be submitted to the licensing agency for approval...(2)A copy of the Admission Agreement...This requirement is not met as evidenced by
	Deficient Practice Statement
1 2 3 4
	POC Due Date: 12/17/2024
	Plan of Correction
1 2 3 4	No proof of correction is required facility is closed.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Desaree Perera	TELEPHONE: (818) 596-4347
Valeria Conway	TELEPHONE: (818) 454-0485
	DATE: 12/17/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024

LIC809 (FAS) - (06/04)

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