195850277-11-6-2023-29-AS-KHEN-CXSR7F-20231121114616

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850277
Report Date: 11/06/2023
Date Signed: 11/06/2023 03:42:37 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
11/01/2023 and conducted by Evaluator Emily Peraldi

COMPLAINT CONTROL NUMBER: 29-AS-20231101082803

FACILITY NAME:	BENTLEY HILLS		FACILITY NUMBER:	195850277
ADMINISTRATOR:	AQUINO, ROBIN		FACILITY TYPE:	740
ADDRESS:	22740 HATTERAS STREET		TELEPHONE:	(213) 478-0460
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91367
CAPACITY:	6	CENSUS: 4	DATE:	11/06/2023
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Vanessa Barcela Haavsgard, Administrator		TIME COMPLETED:	03:50 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Licensee failed to follow Health and Safety Code 1569.191.
Staff did not ensure that medications were not accessible to the residents.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Emily Peraldi conducted an unannounced initial complaint visit at the facility today. At 8:46 a.m., the LPA met with staff and explained the reason for the visit. At 8:57 a.m., the Administrator, Vanessa Barcela Haavsgard arrived at the facility.

At 8:58 a.m., the LPA conducted an interview with the Administrator. At 9:16 a.m., the LPA obtained copies of pertinent documents. Starting at 10:03 a.m., the LPA conducted interviews with two (2) staff. At 10:19 a.m., the LPA along with the Administrator conducted a physical plant tour. At 1:56 p.m., the LPA conducted an interview with Licensee representative, Stephany Perez.

Continued on LIC 9099-C.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2023

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-20231101082803

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: 11/06/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Regarding the allegation: Licensee failed to follow Health and Safety Code 1569.191. It was alleged that the facility is being advertised and presented by a different name, “True Living Care.” During the physical plant tour, the LPA observed signs, pamphlets, and business cards with the name of “True Living Care.” The LPA observed the license of the facility with the current name, BENTLEY HILLS. The Administrator explained that her and husband bought the business in June 2023 and took full control of the facility in July 2023. The Administrator stated that an application for a license has not been submitted. The Administrator explained that they are waiting for the Fire Department inspection. The Administrator explained that the previous Administrator and Licensee notified the Department and residents about the sell and change of ownership. Per record review conducted by the LPA on 11/06/2023, it was confirmed that the Licensee informed the Department on 6/14/2023 that the licensee accepted an offer for sale of this location. On 06/22/2023, the Licensee informed the residents about the pending sale of the facility. The LPA explained to the Administrator that an application for licensure of "True Living Care” would have to be submitted. During the interview with the Licensee representative it was revealed that the current Licensee is still involved and oversees the facility. The Licensee representative confirmed that the application of a new license is still being worked on. Although the facility is going to change ownership and name, the current License is still valid under BENTLEY HILLS, there the facility cannot advertise or be presented by a different name, “True Living Care.” Based on the observation, record review and interviews, the preponderance of evidence standard has been met, therefore the above allegation is deemed Substantiated.
Regarding the allegation: Staff did not ensure that medications were not accessible to the residents. On 11/01/2023, the Department received a complaint alleging that staff did not ensure that medications were inaccessible to residents. On 10/27/2023, a credible witness observed and noted the following: observed a caregiver walk away from medications (Liquid medication on a food tray and entire bottle) on the kitchen counter while residents were dining in the kitchen. During the visit, the LPA observed the medications locked in an office adjacent to the kitchen. Interviews with the Administrator and staff revealed that the area where the medications are located is inaccessible to residents. The LPA reminded the Administrator and staff that all medications need to be inaccessible to residents especially for residents diagnosed with dementia. Based on the observation from a credible witness, 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 and California Health and Safety Code the following deficiencies were observed and cited during the visit (See 9099-D).Civil Penalties assessed and issued in the amount of $250. Exit interview conducted. A copy of the report and appeal rights were provided.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 29-AS-20231101082803

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: 11/06/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 11/07/2023 Section Cited CCR 87705(f)(2)	1 2 3 4 5 6 7	87705 (f)(2) Care of Persons with Dementia (f) The following shall be stored inaccessible to residents with dementia: (2) Over-the-counter medication... vitamins....This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The Administrator stated that the facility staff will be trained on the above regulation. Civil Penalties assessed in the amount of $250.
	8 9 10 11 12 13 14	Based on credible witness observation, the licensee did not comply with the section cited above as a caregiver walked away from medications in front of residents which poses an immediate health& safety risk to persons in care.	8 9 10 11 12 13 14
Type B 11/10/2023 Section Cited HSC 1569.191(b)	1 2 3 4 5 6 7	§1569.191(b) Sale of licensed facility;...(b) Except as...the property and business shall not be transferred until the buyer qualifies for a license or provisional license within the appropriate provisions of this chapter.This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee Representative agreed to submit documents and application needed for the change of ownership. Licensee Representative will provide proof to CCL of submitting the documents by POC due date.
	8 9 10 11 12 13 14	Based on observations, interview and record review the Licensee did not comply with the above cited section, as the facility is being advertised and presented by a different name, “True Living Care” which poses a potential personal rights risk to residents in care.	8 9 10 11 12 13 14

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 Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 3