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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609123
Report Date: 02/24/2021
Date Signed: 02/24/2021 09:43:32 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
MONTERY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/07/2020 and conducted by Evaluator Susan Campos
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20200807100830
FACILITY NAME:BENTLEY SUITES BY SERENITY CARE HEALTHFACILITY NUMBER:
197609123
ADMINISTRATOR:MONA ALCARAZFACILITY TYPE:
740
ADDRESS:851 4TH STREETTELEPHONE:
(213) 478-0800
CITY:SANTA MONICASTATE: CAZIP CODE:
90403
CAPACITY:44CENSUS: 26DATE:
02/24/2021
UNANNOUNCEDTIME BEGAN:
02:47 PM
MET WITH:Renel CabralTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Facility staff recorded resident without permission
Resident was intimidated by staff
INVESTIGATION FINDINGS:
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On 2/24/2021, Licensing Program Analyst (LPA)/ Campos, initiated a subsequent complaint investigation visit to deliver findings for the allegations above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s subsequent complaint investigation was conducted telephonically with Renel Cabral, Administrator. The investigation consisted of the following: LPA conducted telephone interviews with (4) staff members and also conducted client teleconference/ zoom interviews with (3) clients on 8/12/20. In addition, on 8/11/21, LPA conducted a telephone/video inspection, of the facilities’ physical plant and food supply for health and safety. Areas covered, in the teleconference, included: front door, common areas, office, dining room, kitchen, outdoor patio, TV room, and food supply. LPA also reviewed the following documents provided by Bentley Suites: Staff Roster, Client Roster, Staff Schedule, and House Rules.

Report continued on LIC 9099C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Susan CamposTELEPHONE: (323) 629-7445
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
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
MONTERY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/07/2020 and conducted by Evaluator Susan Campos
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20200807100830

FACILITY NAME:BENTLEY SUITES BY SERENITY CARE HEALTHFACILITY NUMBER:
197609123
ADMINISTRATOR:MONA ALCARAZFACILITY TYPE:
740
ADDRESS:851 4TH STREETTELEPHONE:
(213) 478-0800
CITY:SANTA MONICASTATE: CAZIP CODE:
90403
CAPACITY:44CENSUS: 26DATE:
02/24/2021
UNANNOUNCEDTIME BEGAN:
02:47 PM
MET WITH:Renel CabralTIME COMPLETED:
04:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident was inappropriately touched by staff
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 2/24/2021, Licensing Program Analyst (LPA)/ Campos, initiated a subsequent complaint investigation visit to deliver findings for the allegation above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s subsequent complaint investigation was conducted telephonically with Renel Cabral, Administrator. The investigation consisted of the following: LPA conducted telephone interviews with (4) staff members and also conducted client teleconference/ zoom interviews with (3) clients on 8/12/20. In addition, on 8/11/21, LPA conducted a telephone/video inspection, of the facilities’ physical plant and food supply for health and safety. Areas covered, in the teleconference, included: front door, common areas, office, dining room, kitchen, outdoor patio, TV room, and food supply. LPA also reviewed the following documents provided by Bentley Suites: Staff Roster, Client Roster, Staff Schedule, and House Rules.

Report continued on LIC 9099
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Susan CamposTELEPHONE: (323) 629-7445
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 11-AS-20200807100830
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
MONTERY PARK, CA 91754
FACILITY NAME: BENTLEY SUITES BY SERENITY CARE HEALTH
FACILITY NUMBER: 197609123
VISIT DATE: 02/24/2021
NARRATIVE
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Allegation: Resident was inappropriately touched by staff

The investigation revealed, per LPA interviews, with (4) staff members, and (3) residents from the Bentley Suites that resident was not inappropriately touched by staff.

S1 informed LPA that not aware of a resident that has been inappropriately touched by a staff member nor has witnessed a staff person be inappropriately touched by a staff person. LPA interviewed S3, and informed LPA that has never touched a resident at Bentley Suites inappropriately. In addition, LPA interviewed (4) Bentley Suites staff persons and 4 of the 4 staff members interviewed, informed LPA, that they are not aware of a staff person that has touched a resident inappropriately by a staff person. Also 4 of 4 staff members interviewed informed LPA that they have never witnessed a staff person inappropriately touch a resident in the facility. Furthermore, LPA interviewed (3) residents, and 2 of 3 residents interviewed, informed LPA, that they have not been touched inappropriately by a staff member at the Bentley Suites facility. Also 2 of 3 residents interviewed, informed LPA that they are not aware of a resident in the facility that has been touched inappropriately by a staff person

Based on information gathered, LPA did not find sufficient evidence to support allegation "Resident was inappropriately touched by staff ”

Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated.

A telephonic exit interview was conducted with Renel Cabral, Facility Manager, and a hard copy of a LIC 9099 was provided via email for signature.

SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Susan CamposTELEPHONE: (323) 629-7445
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 11-AS-20200807100830
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
MONTERY PARK, CA 91754
FACILITY NAME: BENTLEY SUITES BY SERENITY CARE HEALTH
FACILITY NUMBER: 197609123
VISIT DATE: 02/24/2021
NARRATIVE
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Allegation: Facility staff recorded resident without permission

The investigation revealed, per LPA interviews, with (4) staff members, and (3) clients from the Bentley Suites facility, that the facility had recorded a resident without permission. LPA interviewed R1, and was informed by R1, that did not know S2, recorded, with cell phone, a conversation with R1 on 8/3/20, and became aware of the voice recorded conversation, when S3 played the voice recording, on 8/4/20, of R1 and S2. R1 informed LPA, that S3 ask R1 to listen to the cell phone recording, and R1 stated recognized voice was R1’s and S2. S2 informed LPA that recorded with, own cell phone, a conversation, with R1 on 8/3/20, without R1's permission or knowledge. S2 further stated, that R1’s voice recording was an accident, and that S2’s cell phone, recorded the conversation, without S2 knowing it, and S2 discovered the recording, of the cell phone conversation, after the conversation with R1. S2 also stated, that once heard recorded conversation, then S2 emailed the voice recorded cell phone conversation with R1, to S3's cell phone, because S2 wanted S3 to know what R1 said about S3. LPA interviewed S3, and was informed that received S2 email of voice recorded conversation between S2 and R1.

On 8/12/20, LPA was informed by S2 that voice recorded R1, per cell phone, and sent voice recording to S3.

Based on information gathered, LPA did find sufficient evidence to support allegation "Facility staff recorded resident without permission”

Allegation: Resident was intimidated by staff

The investigation revealed, per LPA interviews, with (4) staff members, and (3) clients from the Bentley Suites facility that the facility had intimidated a resident. R1 informed LPA, that on 8/11/20, S3, had approached R1, in the TV room, and yelled profanity directly at R1. Also, LPA interviewed R2, and R2 stated that was in the TV room with R1 on 8/11/20, and witnessed S3 come into the TV room, and yell profanity directly at R1, and then saw S3 leave the room.

On 8/12/21, LPA was informed by R1 and R2 that S3 yelled profanity at R1.

Based on information gathered, LPA did find sufficient evidence to support allegation "Resident was intimidated by staff”.Based on LPA observations and interviews which were conducted record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D. A telephonic exit interview was conducted with Renel Cabral, Facility Manager, and a hard copy of a LIC 9099, LIC9099 and appeals form was provided via email for signature.

SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Susan CamposTELEPHONE: (323) 629-7445
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 11-AS-20200807100830
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
MONTERY PARK, CA 91754

FACILITY NAME: BENTLEY SUITES BY SERENITY CARE HEALTH
FACILITY NUMBER: 197609123
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/24/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/24/2021
Section Cited
CCR
87468.2(a)(1)
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87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privatelyoperated residential care facilities for the elderly shall have all of the following personal rights:(1) To have a reasonable level of personal privacy in accommodations, medical treatment, personal care and assistance, visits, communications, telephone conversations, use of the Internet, and meetings of resident and family groups.
This requirement is not met as evidenced by:

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Administrator will provide LPA, per fax, staff meeting sign in sheet, regarding review of resident's personal rights, specifically addressing No recording by 3/3/21. LPA fax number (323) 981-1781

POC Due Date is 3/3/21
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Based on interview and record review, the licensee failed to ensure the resident's personal rights due to staff person recorded resident conversation and distributed recording to other staff members, which posed a potential health risk to residents in care.
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Type B
02/24/2021
Section Cited
CCR
87468.1(a)(3)
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87468.1 Personal Rights of Residents in All Facilities(a)Residents in all residential care facilities for the elderly shall have all of the following personal rights:(3)To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination.
This requirement is not met as evidenced by:
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Administrator will provide LPA, per fax, staff meeting sign in sheet, regarding review of resident's personal rights - specifically addressing No intimidation and No profanity towards residents, by 3/3/21. LPA fax number (323) 981-1781

POC Due Date is 3/3/21
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Based on interview and record review, the licensee failed to ensure a resident's personal rights due to staff person yelling profanity and intimidating a resident, which posed a potential health risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Susan CamposTELEPHONE: (323) 629-7445
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 5