197609123-12-10-2020-11-AS-AJKK-BXTV38-20210201150419

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609123
Report Date: 10/17/2020
Date Signed: 12/10/2020 02:17:04 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/06/2020 and conducted by Evaluator Troy Agard

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20200806161738

FACILITY NAME:	BENTLEY SUITES BY SERENITY CARE HEALTH		FACILITY NUMBER:	197609123
ADMINISTRATOR:	MONA ALCARAZ		FACILITY TYPE:	740
ADDRESS:	851 4TH STREET		TELEPHONE:	(213) 478-0800
CITY:	SANTA MONICA	STATE: CA	ZIP CODE:	90403
CAPACITY:	44	CENSUS: 26	DATE:	10/17/2020
		UNANNOUNCED	TIME BEGAN:	01:16 PM
MET WITH:	Renel Cabrel, Administrator		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Resident sustained injuries while in care.
Staff did not properly clean resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Troy Agard, conducted a subsequent complaint investigation to deliver findings. Due to the situation surrounded Coronavirus (Covid 19), and to implement mitigation measures, the complaint investigation was conducted via FaceTime with Administrator, Renel Cabrel. LPA Agard explained the purpose of this visit is to gather information regarding the complaint allegations.

On 10/17/2020, LPA Agard conducted a telephonic visit with Administrator, Renel Cabrel, to deliver findings.

On 08/14/2020, LPA Agard conducted initial 10 day visit and met with Administrator Renel Cabrel. LPA completed a walkthrough of the facility via FaceTime, interviewed Administrator, and requested copies of facility records. LPA received the following records: A copy of the staff roster, a copy of the staff personnel records, a copy of the resident roster, a copy of the staff schedule, copies of medication administration, a copy of physician’s report and a copy of annual training.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2020

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20200806161738

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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 SUITES BY SERENITY CARE HEALTH	FACILITY NUMBER: 197609123
	VISIT DATE: 10/17/2020

NARRATIVE

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The investigation revealed the following: Regarding the allegation, resident sustained injuries while in care. Per the reporting party, its being alleged, a resident that resides at this facility sustained injury while in care. On 09/08/2020, LPA Agard interviewed staff 1-5. It was revealed no resident has sustained any injuries that may have cause bruising. Staff mentioned not observing any bruising on the resident’s while assisting them with showering and toileting. LPA Agard interviewed resident’s 1-6. R1 was unable to answer the questions. R2-6 revealed through their interviews that they have not had any injuries that may have resulted in bruising. During a review of the medication administration records, it was observed, some residents are on medications that causes them to be more susceptible to bruising.

Regarding the allegation, staff did not properly clean resident. Per the reporting party, it’s being alleged, a resident that resides there is not being cleaned that well. On 09/08/2020, LPA Agard interviewed staff 1-5. It was revealed, residents are showered 2 to 3 times weekly by caregivers and more often depending on the significance of their bowel movement. It was also revealed; two caregivers assist with each resident’s shower. On 09/08/2020, LPA Agard interviewed resident’s 1-6. R1 was unable to answer the questions. R2-6 revealed through their interview, staff do a good job of supporting residents with their ADL’s and confirmed feeling clean. R2 states, they do a good job, R3 states, they do more than a good job, R4 is independent in their ADL’s, R5 & R6 states, the facility staff assist them, and do a good job.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

A telephone exit interview was conducted with Renel Cabel and a hard copy was provided via email for a signature.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2020

LIC9099 (FAS) - (06/04)

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