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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320301
Report Date: 08/19/2024
Date Signed: 08/19/2024 04:55:48 PM


Document Has Been Signed on 08/19/2024 04:55 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245



FACILITY NAME:BENTLEY MANORFACILITY NUMBER:
198320301
ADMINISTRATOR:ALCARAZ, MONA MFACILITY TYPE:
740
ADDRESS:3425 MCLAUGHLIN AVENUETELEPHONE:
(213) 478-0460
CITY:LOS ANGELESSTATE: CAZIP CODE:
90066
CAPACITY:27CENSUS: 24DATE:
08/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Mona Alcaraz-Director/AdministratorTIME COMPLETED:
04:55 PM
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Licensing Program Analyst (LPA) Troy Watson conducted an unannounced visit to Bentley Manor on 08/19/2024 at 09:15 AM. The LPA met with the Administrator Mona Alcaraz, and the purpose of the visit was explained. Facility is licensed to serve 27 non- ambulatory residents and currently has a census of (24) of which 3 are bed-ridden and the facility has an approved hospice waiver for eight residents. Some residents are diagnosed with dementia and some residents are receiving hospice care services. The facility does not handle any of the resident’s money.

Because of time restraints the inspection could not be completed at this time

SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (424) 544-1088
LICENSING EVALUATOR NAME: Troy WatsonTELEPHONE: (424) 544-1069
LICENSING EVALUATOR SIGNATURE:
DATE: 08/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/19/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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