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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320302
Report Date: 07/26/2022
Date Signed: 07/26/2022 04:18:49 PM


Document Has Been Signed on 07/26/2022 04:18 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 SUITESFACILITY NUMBER:
198320302
ADMINISTRATOR:AQUINO, ROBINFACILITY TYPE:
740
ADDRESS:851 4TH STREETTELEPHONE:
(213) 478-0460
CITY:SANTA MONICASTATE: CAZIP CODE:
90403
CAPACITY:44CENSUS: 23DATE:
07/26/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Mona Alcaraz-AdministratorTIME COMPLETED:
04:20 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 7/25/2022.

LPA observed the following on 7/26/2022
- Smoke detectors in room 1, 2, 3 13, 14, and 15 are operational.

The following still needs to be completed:
1. Facility layout does not match floor plan provided to CAB.
2. Bathrooms as well as kitchen sink had water temperatures ranging from 99.8F to 144F.
3. Bedrooms 3, 28, 15 were shared rooms and were missing the second bed and room 10 had no bed at all.
4. Bedrooms 12, 17, 18, 19, and 21 had no light.

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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