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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320301
Report Date: 07/26/2022
Date Signed: 07/26/2022 02:10:06 PM


Document Has Been Signed on 07/26/2022 02:10 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
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754



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: 21DATE:
07/26/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:53 AM
MET WITH:Mona Alcaraz- AdministratorTIME COMPLETED:
02:15 PM
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On 7/26/2022 Licensing Program Analyst (LPA), Stephanie Cifuentes conducted an unannounced follow-up inspection to the above facility for purpose of following up on the plan of correction issued during the change of ownership pre-licensing evaluation completed on 7/22/2022.

LPA observed the following on 7/26/2022
-A bed was placed in room 17, facility now has 27 bed, which is requested capacity.
-Water temperature in 14 of the bathrooms is under 105F
-No locks on kitchen cabinets or drawers for sharps or toxins, toxins found in cabinet and knives in drawer. Done
-several rooms are in need of repairs such as new screens in windows, small holes in bathroom wall, overhead lights not working. LPA went through rooms and saw that repairs had been made.
-Extra dressers were added to Room 3 to create additional storage.
-Pests were not found in two residents rooms.

The following still needs to be completed:
-On 7/26/2022 and 7/22/2022 pests were found in kitchen.

Exit interview conducted with Administrator Mona Alcaraz and a copy of this report was provided.

SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie CifuentesTELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:
DATE: 07/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/26/2022
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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