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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608988
Report Date: 08/30/2021
Date Signed: 09/07/2021 02:56:54 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
MONTERY 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:
08/30/2021
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Bioseh OgbechieTIME COMPLETED:
01:35 PM
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Regional Manager’s (RM) Benita Yates, Araceli Ramirez, and Jill Nakata, acting Regional Manager Marina Stanic Licensing Program Manager (LPM) Lisa Hicks, Adeline Ho, Janae Hammond, Jeralyn “Jeri” Pfannenstiel and acting Licensing Program Manager Sean Haddad participated in a meeting together with licensee representatives for Serenity Care Health EA Corporation, Binko Corp and Serenity Care Health Corporation to discuss licensee’s closure plan for all facilities under Serenity Care Health EA Corporation, Binko Corp and Serenity Care Health Corporation . Due to the situation surrounding the Corona Virus Disease 2019 (COVID-19), and to implement mitigation measures, today’s conference was conducted via Microsoft Team with Licensee representatives Bioseh Ogbechie, Joseph Chen and Nicolas Spigner.

The purpose of today's conference was to discuss facility closure plan per the Decision and Order issued on August 25, 2021. Additionally, the following was discussed:

It was addressed in the meeting that licensee will have until October 29, 2021 to relocate all residents for facilities listed under Serenity Care Health EA Corporation, Binko Corp and Serenity Care Health Corporation (Bentley Suites by Serenity Care Health # 197609123, Bentley Manor by Serenity Care Health # 198601877, Bentley Hills by Serenity Care Health # 197608988, Bentley House # 198601591, Henrietta’s Leven Oaks by Serenity Care Health # 198602418, Serenity Care Health Evergreen # 198602285, Serenity Care Health Evergreen Cottage # 198602286, Kaego’s Richman Gardens by Serenity Care Health # 306005552 and Hannah’s Home by Serenity Care Health # 197609122) to other licensed facilities.
SUPERVISOR'S NAME: Ley ArquisolaTELEPHONE: (916) 657-2592
LICENSING EVALUATOR NAME: Benita YatesTELEPHONE: (323) 981-3962
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2021
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 2
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
MONTERY PARK, CA 91754
FACILITY NAME: BENTLEY HILLS BY SERENITY CARE HEALTH
FACILITY NUMBER: 197608988
VISIT DATE: 08/30/2021
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Licensee representatives were informed they shall not accept any new residents at any facility and must submit a closure plan for facilities with a capacity over 12 (Henrietta’s Leven Oaks by Serenity Care Health, Bentley Manor by Serenity Care Health, Bentley Suites by Serenity Care Health and Kaego’s Richman Gardens by Serenity Care Health). The following Title 22 Regulation Sections were discussed, and materials provided during the meeting;

· Eviction Procedures 87224 (RCFE)


· H&S Code 1569.682
· PIN 18-17-ASC Facility Closure Requirements
· Reporting Requirements 87211 (RCFE)

Phases 1, 2 and 3 were discussed. Phase 1 (draft of the closure plan along with eviction notice), Phase 2 (following approved closure plan, notifying placement agencies along with LTCO/ SS Administration), Phase 3 (notification of facility closure).

The documents listed below were requested from Mr. Ogbechie and Mr. Ogbechie stated that copies will be provided to CCL by the end of business day on Friday September 3, 2021;

· 60 Days Written Notice (draft for Residents/ draft for Family/ Responsible party)
· Closure Plan (Including: Client Roster, Ambulatory Status, Rent Payee, Conservator/POA)
· Transfer of P&I moneys
· List of exempted staff
· List of utilities & vendors

An exit interview was conducted, and a copy of this report was provided to Executive Director Joseph Chen via email.
SUPERVISOR'S NAME: Ley ArquisolaTELEPHONE: (916) 657-2592
LICENSING EVALUATOR NAME: Benita YatesTELEPHONE: (323) 981-3962
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2021
LIC809 (FAS) - (06/04)
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