<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608988
Report Date: 08/02/2021
Date Signed: 08/02/2021 12:53:57 PM

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: 4DATE:
08/02/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Staff, Soraya Matian TIME COMPLETED:
01:00 PM
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
Licensing Program Analyst (LPA) Agard conducted an unannounced case management visit to this facility to ensure the Accusation/CDSS No. 6120010302F was posted as required by Law, and that the residents, the residents' responsible parties, and the Local Long Term Care Ombudsman have all been notified of the Accusation. LPA explained the purpose of the visit to staff Soraya Matian. Facility Manager was not present to assist with the tour.

During today's visit, the physical plant was toured. Copies of staff/resident rosters and resident's Identification and Emergency Information was requested but not obtained. Proof of liability insurance was requested but not obtained.

The Accusation was served to Licensee "Serenity Care Health Corporation" via certified mail on June 16, 2021. The Accusation was not observed posted in a conspicuous location. Licensee did not provide written notification to the residents, their responsible parties, the long-term care ombudsman as required. A copy of the Accusation was provided to staff. Staff were instructed to immediately post the Accusation.

LPA spoke to Administrator/Licensee Bioseh Ogbechie. In speaking with Administrator, he claims the accusations have been placed in the facility file cabinet to be posted but is unsure where. He states, he needs to speak with his lawyer before he can provide licensing with a copy of LIC 9120. He states the corporation is in the process of notifying the families, residents and their responsible party of the Accusation. He states the liability insurance has been dropped due to the premium being raised and that the facility is possibly operating without it at this time.

Health & Safety Code Section 1569.38 specifically states that licensee is required to provide written

(See LIC 809C for continuation of report)
SUPERVISOR'S NAME: Angela J KendrickTELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy AgardTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 HEALTH
FACILITY NUMBER: 197608988
VISIT DATE: 08/02/2021
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
notification to a resident, the residents' responsible party, if any, and the local Long-Term Care Ombudsman within 10 days from the date indicated on the Accusation. The licensee is also required to post the Accusation in a conspicuous location, written in at least 14-point type, stating that legal action is being taken against the facility to revoke the license. The 10th day falls June 26, 2021.

Health & Safety Code Section 1569.38 specifically states that licensee is required to provide written notification to a resident, the residents' responsible party, if any, and the local Long-Term Care Ombudsman within 10 days from the date indicated on the Accusation. The licensee is also required to post the Accusation in a conspicuous location, written in at least 14-point type, stating that legal action is being taken against the facility to revoke the license. The 10th day falls June 26, 2021.

Civil penalties will be assessed against any facility that fails to take corrective action within described time periods. Per California Health & Safety Code Section 1569.38, you are hereby notified that a $100 civil penalty will be assessed beginning August 3rd, 2021, if Health & Safety Code Section 1569.38 requirements are not met. The total civil penalty for each day shall not exceed $100/day regardless of the number of notices the licensee fails to send that day. The total civil penalty for a continuous violation shall not exceed $5,000.

Civil penalties will accrue until Community Care Licensing has received proof that all required parties have received written notification of the revocation action.

A civil penalty invoice will be received. Payment is due when billed. Payment must be made by a personal, business, or cashier's check or money order made payable to the California Department of Social Services. Please write the facility number and invoice number on your check and include a copy of your invoice with the payment. You will find the invoice number on our invoice. DO NOT SEND CASH.

Deficiencies are cited per Health & Safety Code Sections 1569.38 & 1569.605 and Title 22 87705, 87355 & 87508

LPA spoke with Bioseh Ogbechie and explained the citations, civil penalty assessment, and appeal rights.

Exit interview was conducted with staff Soraya Matian. A copy of the report and appeal rights were provided.
SUPERVISOR'S NAME: Angela J KendrickTELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy AgardTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2021
LIC809 (FAS) - (06/04)
Page: 5 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 HEALTH
FACILITY NUMBER: 197608988
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/02/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/03/2021
Section Cited

1
2
3
4
5
6
7
WRITTEN NOTICE OF REVOCATION.
Upon providing the notice described in subdivision (b), the licensed residential care facility shall also post a written notice, in at least 14-point type, in a conspicuous location in the facility.... (1) The date of the notice. (2) The name of the residential care facility for the elderly.
8
9
10
11
12
13
14
(3) A statement that a copy of the most recent licensing report ... (4) The name and telephone number of the contact person designated by the Community Care Licensing Division of the department to provide information on the license status of the facility. Based on observation during today's visit the Accusation was not posted in a conspicuous location.
8
9
10
11
12
13
14
Type A
08/03/2021
Section Cited

1
2
3
4
5
6
7
POSTING OF LICENSING REPORTS: WRITTEN NOTICE OF REVOCATION. A licensed residential care facility for the elderly shall provide written notice to a resident, the resident’s responsible party, if any, and the local long-term care ombudsman, within 10 days from the occurrence of either of the following events: The department commences proceedings to suspend or revoke the license of the facility pursuant to Section 1569.50.
8
9
10
11
12
13
14
Accusation posting was not observed in a conspicuous location. Required parties have not been issued a written notice of the accusation. Administrator Bioseh Ogbechie stated he could not confirm receipt of Accusation.
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: Angela J KendrickTELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy AgardTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 08/02/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/02/2021
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 HEALTH
FACILITY NUMBER: 197608988
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/02/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/03/2021
Section Cited

1
2
3
4
5
6
7
POSTING OF LICENSING REPORTS: WRITTEN NOTICE OF REVOCATION
A licensee who fails to comply with the requirements of subdivision (b) or (c) shall be liable for civil penalties in the amount of one hundred dollars ($100) for each day of the failure to provide notification as required in this section. The total civil penalty for
8
9
10
11
12
13
14
CONTINUATION- each day shall not exceed one - hundred dollars ($100) regardless of the number of notices that the citation licensee fails to send that day. The total civil penalty for a continuous violation of subdivision (b) or (c) shall not exceed five thousand dollars ($5,000). CIVIL PENALTIES of $ 2,000 are assesed for failure to provide notification as required.
8
9
10
11
12
13
14
Type B
08/02/2021
Section Cited

1
2
3
4
5
6
7
§1569.605 LIABILITY INSURANCE; COVERAGE REQUIREMENTS. On and after July 1, 2015, all residential care facilities for the elderly ... shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million
8
9
10
11
12
13
14
citation continuation- ($3,000,000) in the total annual dollars aggregate, caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees.

Based on observation and interviews conducted the failed to provide proof of liability insurance during the visit.
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: Angela J KendrickTELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy AgardTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 08/02/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/02/2021
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 HEALTH
FACILITY NUMBER: 197608988
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/02/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/04/2021
Section Cited

1
2
3
4
5
6
7
Registers of residents shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Registers may be removed if necessary for copying. Removal of registers shall be subject to the following requirements:
8
9
10
11
12
13
14
This requirment was not met as evidence by: LPA requested record from Licensee/Admin and was unable to obtain a copy due to Licensee's request to follow up with his attorney. Which poses a potential health and safety violation to the residents in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7

1
2
3
4
5
6
7
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: Angela J KendrickTELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy AgardTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 08/02/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/02/2021
LIC809 (FAS) - (06/04)
Page: 2 of 5