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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608988
Report Date: 01/20/2021
Date Signed: 04/27/2021 10:13:32 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:BENTLEY HILLS BY SERENITY CARE HEALTHFACILITY NUMBER:
197608988
ADMINISTRATOR:OGBECHIE, BIOSEHFACILITY TYPE:
740
ADDRESS:3121 CASTLE HEIGHTS AVENUETELEPHONE:
(213) 478-0472
CITY:LOS ANGELESSTATE: CAZIP CODE:
90034
CAPACITY:6CENSUS: 3DATE:
01/20/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:28 AM
MET WITH:Mona AlcarazTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Ulysses Coronel conducted an unannounced Plan of Corrections visit to Bentley Hills By Serenity Care Health. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s visit was conducted telephonically with Mona Alcaraz facility administrator.

87468.1(a)(11) Personal Rights of Residents in All Facilities. Residents in all residential care facilities for the elderly shall have all of the following personal rights: To have their visitors, including ombudspersons and advocacy representatives, permitted to visit privately during reasonable hours and without prior notice, provided that the rights of other residents are not infringed upon. The POC due date was 01/11/2021. A civil penalty of $900 is assessed at $100 per day, for the period of 01/12/2021 thru 01/20/2021 beginning on the day after the Plan of Correction was due.

Civil Penalties Assessed, telephonic exit interview conducted, “The licensee was provided a copy of their appeal rights and their signature on this form acknowledges receipt of these rights.” appeal rights given.
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ulysses CoronelTELEPHONE: (951) 212-8917
LICENSING EVALUATOR SIGNATURE:

DATE: 01/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2021
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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