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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608988
Report Date: 01/26/2022
Date Signed: 01/26/2022 01:48:17 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: 6DATE:
01/26/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:26 PM
MET WITH:House Manager, Sheila AuinganTIME COMPLETED:
01:50 PM
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Licensing Program Analyst (LPA) Troy Agard conducted an unannounced Case Management visit to the above facility. LPA arrived and met with House Manager, Sheila Auingan. LPA explained the reason for the visit is to follow up on the citation issued on September 24, 2021.

LPA / Regional office was provided a copy of the liability insurance for Serenity Care Health Corporation DBA BENTLEY HILLS BY SERENITY CARE HEALTH. The copy of the document provided to LPA shows coverage is 1 million per occurrence and 3 million aggregate and has the same policy number as the other facility’s under Serenity Care Health Corporation. As of today’s visit, no changes have been made to the liability insurance coverage provided to LPA.

The facility has failed to comply with the POC that was issued on 09/24/2021. Additional citations are being issued under regulation 1569.605 LIABILITY INSURANCE; COVERAGE REQUIREMENTS. On and after July 1, 2015, all residential care facilities for the elderly, except those facilities that are an integral part of a continuing care retirement community, 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 dollars ($3,000,000) in the total annual aggregate, caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees.

Civil Penalties assessed and an exit interview was conducted. A copy of this report was provided with appeal rights.
SUPERVISOR'S NAME: Angela J KendrickTELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy AgardTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2022
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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