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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608988
Report Date: 12/03/2021
Date Signed: 12/03/2021 02:42:20 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: 5DATE:
12/03/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:22 PM
MET WITH:House Manager, Sheila AuinganTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Agard conducted an unannounced Case Management visit to the facility above. LPA Agard arrived and spoke with House Manager, Sheila Auingan. LPA explained the reason for the visit is to follow up on citation issued on September 24, 2021.

During today’s visit, LPA Agard obtain a copy of the liability insurance coverage and was advised that the facility is currently covered effective 09/30/2021.

An exit interview was conducted, and a copy of this report was given to caregiver.
SUPERVISOR'S NAME: Angela J KendrickTELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy AgardTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2021
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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