197609123-3-1-2022-11-AS-EMAZ-CDAV4M-20220408160633

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609123
Report Date: 03/01/2022
Date Signed: 03/01/2022 04:38:44 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
02/02/2022 and conducted by Evaluator Stephanie Cifuentes

COMPLAINT CONTROL NUMBER: 11-AS-20220202081322

FACILITY NAME:	BENTLEY SUITES BY SERENITY CARE HEALTH		FACILITY NUMBER:	197609123
ADMINISTRATOR:	RENEL CABRAL		FACILITY TYPE:	740
ADDRESS:	851 4TH STREET		TELEPHONE:	(213) 478-0800
CITY:	SANTA MONICA	STATE: CA	ZIP CODE:	90403
CAPACITY:	44	CENSUS: 23	DATE:	03/01/2022
		UNANNOUNCED	TIME BEGAN:	10:02 AM
MET WITH:	Evacita Bata and Robin Aquino		TIME COMPLETED:	04:48 PM

ALLEGATION(S):

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Facility is not allowing visitations.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Stephanie Cifuentes conducted an unannounced subsequent complaint investigation at the facility listed above. LPA spoke with house manager Eva Bata via telephone call prior to entering the facility to conduct risk assessment questionnaire and was informed that facility has no COVID cases nor do any of the clients have symptoms. LPA arrived at facility and was greeted by staff Eva Bata. LPA explained the purposed of the visit was to investigate the allegation listed above and was granted access to the facility.

The investigation consisted of the following:
On 2/8/2022 LPA Cifuentes toured the inside and outside grounds of the facility to conduct a healthy and safety check. LPA spoke with administrator and discussed latest covid visitation PIN. LPA requested copies of the following: client roster, staff roster. On 3/1/2022 LPA Cifuentes interviewed residents 1-resident 4 (R1-R4) and staff 1-staff 4 (S1-S4) regarding the allegation.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2022

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-20220202081322

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: 03/01/2022

NARRATIVE

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Regarding the allegation: Facility is not allowing visitations.

The investigation revealed the following:

The complainant alleges residents at facility were not allowed indoor visitation, only outdoor. On 2/8/2022 LPA Cifuentes saw a memorandum on the door dated 1/3/2021. Memorandum discussed the spread of the Omicron variant of Covid-19 across the country and stated that indoor visits would be paused until further notice. It further stated that indoor visits and indoor traffic from non-essential visitor are not permitted, outdoor visits still available. On 12/31/2021 a Public Health order was released, stating that as of January 7, 2022 outdoor and indoor visitation would be allowed to continue, but indoor visitation would require showing proof of negative COVID-19 test, within one day for antigen testing and within two days for PCR testing, before entry could be allowed to the facility. If Covid-19 isolation was happening in the facility, full PPE would need to be given to the visitor.

LPA spoke to House Manager Evacita Bata and Administrator Robin Aquino on 2/8/2022 who confirmed that facility was only allowing outdoor visitation in front of the facility due to Covid outbreak. LPA Cifuentes told them the latest guidance, referred them to the health order and had them remove the memorandum from the door.
On 3/1/2022 LPA Cifuentes interviewed facility residents R1 -R4 regarding allegation. LPA asked residents if they were allowed visitors and 3 out of 4 stated yes. LPA asked if visits were allowed inside of rooms or outside of the facility. Two of the our stated indoors, one was not sure and the last did not answer. LPA Cifuentes interviewed staff 1-staff 4 regarding allegation. All four staff stated residents were allowed visitors. When LPA asked if they were visiting inside or outside in January, all four interviewed stated residents had visitation outside. Based on the information gathered, there’s sufficient evidence to corroborate the allegations.

Based on the Department's observation, interviews conducted and records reviewed the preponderance of evidence standard has been met, therefore the allegation of " Facility is not allowing visitations" are found to be: Substantiated. California Code of Regulations, Title 22, Division 6, Chapter 8, is being cited on the attached LIC 9099-D.

An exit interview was conducted with Robin Aquino. A hard copy of this report was provided to administrator. The Rights were discussed and a copy of Appeals Procedures for Licensees was provided.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2022

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20220202081322

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: 03/01/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/15/2022 Section Cited CCR 87468.1(a)(11)	1 2 3 4 5 6 7	Personal Rights of Residents in All Facilities To have their visitors, including ombudspersons and advocacy representatives, permitted to visit privately during reasonable hours and without prior notice, provided that the rights of other residents are not infringed upon. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Administrator removed the memo on the door on 2/8/2022 as instructed by LPA and has allowed in room and outdoor visitation as instructed by the health order. Administrator also posted latest visitation guidance on bulletin board by the door. POC cleared during visit.
	8 9 10 11 12 13 14	On 2/8/2022 LPA Cifuentes observed a memo on door of facility stating that indoor visitation would not be allowed in facility, despite the public health officer order of December 31, 2021. This is a personal rights risk to the residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2022

LIC9099 (FAS) - (06/04)

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