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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608988
Report Date: 10/08/2021
Date Signed: 10/22/2021 03:17:12 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:
10/08/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:14 AM
MET WITH:Caregiver, Sheila AuinganTIME COMPLETED:
11:45 AM
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This report is an amendment to visit conducted on 10/08/2021. This report supersedes the case management from 10/08/2021

Licensing Program Analyst (LPA) Troy Agard conducted an unannounced Case Management visit to the above facility. LPA met with Caregiver, Sheila Auingan and was able to gain access. LPA explained the reason for the visit is to follow up on citation issued on September 24, 2021.

LPA Agard was provided a copy of liability insurance for BENTLEY HILLS BY SERENITY CARE HEALTH DBA Bentley Hills. The copy of the document provided to the LPA shows the coverage is 1 million per occurrence and 3 million aggregate for assisted living facilities - 3 locations.



The facility has failed to comply with the POC that was issued on 09/24/2021. The facility failed to meet this requirement and is still not incompliance. 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 their 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: 10/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021
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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