197609123-8-26-2022-11-AS-EMAZ-CHW3T9-20220902183135

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609123
Report Date: 06/30/2021
Date Signed: 08/26/2022 10:25:12 AM

Unsubstantiated

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
06/22/2021 and conducted by Evaluator Stephanie Cifuentes

COMPLAINT CONTROL NUMBER: 11-AS-20210622160623

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: 21	DATE:	06/30/2021
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Eva Bata-Manager		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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A resident calls out for assitance at all hours of the night and no one seems to be helping her.

INVESTIGATION FINDINGS:

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This report serves as an amendment to clarify finding. It does not supersedes the complaint investigation findings reflected on report created 6/30/2021.

Licensing Program Analyst (LPA) Stephanie Cifuentes conducted an initial complaint investigation at above facility. LPA arrived at facility and was greeted by staff. 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 6/30/2021 LPA Cifuentes conducted a tour of facility grounds. Facility is two stories located in a residential neighborhood. Facility ground consists of living room, kitchen, dining room, 22 resident bedrooms with attached bathrooms, side yard with shaded area. LPA interviewed Manager Eva Bata, staff 1-staff 6 (S1-S6) as well as resident 1 through resident 7 (R1-R7). LPA reviewed facility files and requested and received the following documents: staff and client rosters, physicians report and medical records for facility residents.

Unsubstantiated

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: 06/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2021

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-20210622160623

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: 06/30/2021

NARRATIVE

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This report serves as an amendment to clarify finding. It does not supersedes the complaint investigation findings reflected on report created 6/30/2021.

Allegation: A resident calls out for assistance at all hours of the night and no one seems to be helping her.

It is alleged that there is a facility resident who appears distressed at all hours of the night and day and staff is not coming to their aid or comforting them. On 6/30/2021 at 8:30am and 3:15pm LPA Cifuentes spoke with house manager Eva Bata. Mrs. Bata told LPA that when residents ask for assistance staff answers quickly, as they don’t know whether it is an emergency or not. She stated most residents have call buttons they carry with them and will use those if they need assistance, but sometimes they will vocally call for staff as they forget they have the button. Per Administrator Bata only one resident can be loud and sometimes yells. Staff will attend them immediately and they have told staff they just feel like making noise or they saw something in the dark. Other staff interviewed stated when resident yells, they go and comfort them and ask them what they need. On 6/30/2021 during facility walk through LPA Cifuentes did not hear any clients calling out for help. LPA Cifuentes pressed the call button in one of the resident’s rooms and facility staff arrived in one minute to respond to the call. On 6/30/2021 from 9:00am to 12:00pm LPA Cifuentes interviewed Resident 1 to Resident 7 (R1-R7). LPA asked residents how long it took staff to assist then once they requested help. Five of the seven residents interviewed stated they received assistance within a few minutes at most. When asked if the facility was loud or if they heard shouting, five out of seven said no. On 6/30/2021 LPA Cifuentes interviewed Staff 1- Staff 6(S1-S6). Four staff were asked their response time when residents called for assistance. All four staff stated they answered calls from residents within seconds or minutes. LPA asked all six staff if any of the residents yelled or if the facility was loud. Four of the six interviewed answered that only one of the residents tended to yell, but they were not yelling for staff assistance.

Based on LPA’s observation, interviews conducted, and records reviewed, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

An exit interview was conducted with manager Eva Bata and a hard copy 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: 06/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2021

LIC9099 (FAS) - (06/04)

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