197609123-7-7-2021-11-AS-EMAZ-C57URG-20210723154842

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609123
Report Date: 07/07/2021
Date Signed: 07/07/2021 02:06:38 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
06/25/2021 and conducted by Evaluator Stephanie Cifuentes

COMPLAINT CONTROL NUMBER: 11-AS-20210625141817

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:	07/07/2021
		UNANNOUNCED	TIME BEGAN:	12:58 PM
MET WITH:	Eva Bata-Manager		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Stephanie Cifuentes conducted a subsequent complaint investigation at above facility. LPA arrived at facility and was greeted by manager Eva Bata . LPA explained the purposed of the visit was to deliver findings for 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 as well as resident 1 through resident 6. LPA reviewed facility files and requested and received the following documents: staff and client rosters, exterminator service agreement, invoices and visit summaries for GAM Exterminating for the months of January, February, March, April and Terminix for June 2021.

Continued on 9099-C

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: 07/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021

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 3

Control Number 11-AS-20210625141817

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: 07/07/2021

NARRATIVE

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Regarding the allegation: Facility has an insect infestation

The investigation revealed the following:

On 6/30/2021 at 8:30am and 3:15pm LPA Cifuentes spoke with manager Eva Bata. Mrs. Bata told LPA that the facility had bedbugs but that it was a long time ago. Mrs. Bata told LPA that a company was coming in to spray once a month.

On 6/30/2021 from 9:00 am to 10:00pm LPA reviewed facility records. LPA reviewed reports from GAM exterminating, which show that facility had a bed bug infestation in January, which was treated over the course of the next month, and inspections were conducted by GAM Exterminating to see if further treatment and prevention measure were needed. Invoices were also provided showing maintenance treatments completed in March and April, as well as an email confirming service by Terminix on 6/17/2021.

On 6/30/2021 from 10:00 am to 11:00am conducted facility walk through. During facility walk through LPA Cifuentes did see any signs of bedbugs, live or dead, in any of the resident’s rooms.

On 6/30/2021 from 9:00 am to 12:00pm LPA Cifuentes interviewed resident 1 to resident 7. LPA asked residents if they had seen any bed bugs. All seven responded that they had not seen any bed bugs recently. All seven residents stated they had seen not termites in the facility.

Continued on 9099-C

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20210625141817

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: 07/07/2021

NARRATIVE

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On 6/30/2021 LPA Cifuentes interviewed staff 1-6. LPA asked staff if if the facility currently had bed bugs, and all 6 staff responded that the facility did not currently have bed bugs, and 4 staff indicated the facility had them in the past. LPA asked staff 1-staff 6 if the facility had termites and 5 out of 6 stated the facility did not have termites.

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: 07/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 3