198320301-7-7-2023-11-AS-UCOL-CYQR22-20231221113736

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320301
Report Date: 07/07/2023
Date Signed: 07/07/2023 02:19:13 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 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
07/05/2023 and conducted by Evaluator Mario Leon

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20230705090402

FACILITY NAME:	BENTLEY MANOR		FACILITY NUMBER:	198320301
ADMINISTRATOR:	ALCARAZ, MONA M		FACILITY TYPE:	740
ADDRESS:	3425 MCLAUGHLIN AVENUE		TELEPHONE:	(213) 478-0460
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90066
CAPACITY:	27	CENSUS: 25	DATE:	07/07/2023
		UNANNOUNCED	TIME BEGAN:	08:48 AM
MET WITH:	Mona Alcaraz, Chief Health Administrator		TIME COMPLETED:	03:04 PM

ALLEGATION(S):

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Questionable death
Illegal drugs on the premises
Uncleared adult on the premises

INVESTIGATION FINDINGS:

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On 07/07/2023, Licensing program Analyst (LPA) Mario Leon conducted an unannounced subsequent complaint visit to the facility. LPA was met by MaSheila Auingan and later by Mona Alcaraz, who were both informed that this visit was conducted to continue an investigation of the complaint allegations, previously initiated on 07/06/2023.

The investigation consisted of the following:

On 07/06/23, Licensing Program Analyst (LPA) Mario Leon conducted an unannounced compaint visit at this facility.LPA toured the facility and interviewed seven (7) staff (S2-8) and two (2) witnesses (W1-2). LPA requested and reviewed three (3) LIC500 staff rosters dating back to 7/05/2022, one (1) current LIC9020 of resident roster and took photos of death reports (LIC624A) dating back to 06/2022.

Report continues, see LIC9099C.

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Mario Leon	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023

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-20230705090402

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: BENTLEY MANOR	FACILITY NUMBER: 198320301
	VISIT DATE: 07/07/2023

NARRATIVE

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On 07/07/2023 LPA conducted a subsequent visit to the facility and requested and reviewed additional facility records.
LPA further interviewed the same seven (7) staff (S2-8) and interviewed three (3) out of 25 (twenty-five) residents (R2-4).
On 07/06/2023 and 07/07/2023 LPA did not observe R1 or S1 present at the facility, record reviews also indicated that R1 and S1 were never present at the facility and all eleven (11) interviews corroborated that R1 and S1 were never present at the facility.

The investigation revealed the following:

Regarding the allegation: "Questionable death"
According to the LPA's record reviews of resident identification and emergency identifications (LIC601) and Death Reports provided (LIC624A), R1 and S1 were never mentioned from 08/2022 - 07/07/23. Furthermore the LPA's interviews conducted, which were held between all seven (7) staff members, one (1) witness (W1) and three (3) residents (R2-4), there was no evidence to support the allegation listed above as all individuals previously mentioned denied knowledge of R1 or S1. In addition, S3 provided a notice stating R1 and S1 were both never present at the facility. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur. Therefore the allegation is unsubstantiated.

Regarding the allegation: "Illegal drugs on the premises"
According to the LPA's interviews which were held between seven (7) staff members (S2-S8) and one witness (W1), all S2-S8 and W1 have denied the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur. Therefore the allegation is unsubstantiated.

Regarding the allegation: "Uncleared adult on the premises"
According to LPA's record review of all three (3) LIC500 sheets from 07/05/2022 - 07/07/2023, S1 was not listed as present. Furthermore, S1 was not listed on the LIS facility roster summary. Furthermore all seven (7) staff (S2-S8), one (1) witness (W1) and three (3) residents (R2-4) have all denied knowledge of S1. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur. Therefore the allegation is unsubstantiated.

An exit interview was held with MaSheila Auingan and a copy of this report was provided.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Mario Leon	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023

LIC9099 (FAS) - (06/04)

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