<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320302
Report Date: 12/13/2023
Date Signed: 02/28/2024 05:03:15 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
12/05/2023 and conducted by Evaluator David Espana
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20231205153025
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: 36DATE:
12/13/2023
UNANNOUNCEDTIME BEGAN:
08:57 AM
MET WITH:Muriel Cabacugan Asst Administrator TIME COMPLETED:
05:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not administer residents' medications as prescribed.
Staff are not assisting residents with bathing needs.
Staff left residents in soiled clothing.
Staff are not assisting residents with transfers.
Staff not allowing residents to leave the facility.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
This is an amendment of the investigation report delivered on 12/13/2023, the purpose of this amendment is to provide additional information and it does not change the investigation findings. On 12/13/2023 at 08:57 am Licensing Program Analyst (LPA) David España conducted an initiated a 10-day complaint investigation visit for the allegation listed above. Upon arriving at the facility, LPA met with S#1 and S#2 (interviewed by via telephone) who assisted with the visit. The purpose of today’s visit was discussed. Upon arrival at the facility, LPA conducted a risk assessment at the front door. Based on the assessment, the facility is clear of Covid-19 infection. LPA was granted access and allowed to enter the facility to conduct inspections. The investigation consisted of the following: On 12/13/2023 LPA España confirmed there are Thirty-Six (36) total residents in care as of 12/13/2023. LPA confirmed there are Ten (10) total staff employed as of 12/13/2023. LPA confirmed there is only One (1) resident in care who receives oxygen as of 12/13/2023. LPA confirmed there are Six (6) total staff working at the time of visit 12/13/2023. LPA confirmed there are Twenty-Two (22) total residents in care with dementia at the time of visit 12/13/2023. Continued on LIC-9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David EspanaTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024
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 4
Control Number 11-AS-20231205153025
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 SUITES
FACILITY NUMBER: 198320302
VISIT DATE: 12/13/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA confirmed there are Twelve (12) total residents in care with wheelchairs at the time of visit 12/13/2023. LPA confirmed there are Seventeen (17) total residents in care with diapers at the time of visit 12/13/2023. LPA interviewed Six (6) out of Six (6) staff members at the time of visit 12/13/2023. LPA reviewed records of Six (6) out of Thirty-Six (36) total residents in care. LPA interviewed One (1) out of One (1) witness. The LPA also reviewed the following documents provided by Muriel Cabacugan Assistant Administrator (S1): Staff roster, Client roster, Residence and Care Agreement, Needs and Services Plan, Hospice information and Physician Report for Residents, time sheets, MARs log, Shower log, and Death Report etc. Regarding the allegation: Staff do not administer residents' medications as prescribed. LPA interviewed Six (6) of out of Thirty-Six (36) residents in care who stated they take medications in the morning, noon, and at bedtime. LPA interviewed Six (6) of out of Thirty-Six (36) residents in care who stated they receive medications from the MedTech. Review of Six (6) of out of Thirty-Six (36) residents in care medication documents indicate that from October through December 2023, resident were prescribed to take medications in the morning, noon, and bedtime. LPA interviewed Six (6) out of Six (6) staff members who disagree with the allegation “Staff do not administer residents' medications as prescribed.” LPA obtained a copy of Six (6) of out of Thirty-Six (36) residents in care for CCL records. Furthermore, LPA obtained a copy of the Six (6) of out of Thirty-Six (36) residents in care medication log sheet for October, November, December 2023 which indicates that the residents have been taking there medication as prescribed. During this investigation, LPA found did not find sufficient evident to support the above-mentioned allegations. Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has not been met; therefore, the above-mentioned allegation is found to be UNSUBSTANTIATED. Regarding the allegation: Staff are not assisting residents with bathing needs. During an interview with the Six (6) out of Six (6) staff members, stated that every day, there are Five (5) staff members, including S#1 total of Six staff members, tending to the needs of the residents, and on the weekends, there are Six (6) staff. In addition, S1-S6 stated that the hygiene needs of the residents are being met by the facility, which follows a weekly bathing schedule and as needed. LPA confirmed with Six (6) out of Six (6) staff members there is a weekly bathing schedule.During an interview with Six (6) out of Six (6) staff members they stated that the facility is meeting the hygiene needs of the residents, and they bath them every day and as needed in case of incontinence problems. During interviews with Six (6) of out of Thirty-six (36) residents in care stated that the facility meets their hygiene needs and takes showers or baths daily or when needed. Continued on LIC-9099C
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David EspanaTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 11-AS-20231205153025
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 SUITES
FACILITY NUMBER: 198320302
VISIT DATE: 12/13/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
During this investigation, LPA found did not find sufficient evident to support the above-mentioned allegations. Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has not been met; therefore, the above-mentioned allegation is found to be UNSUBSTANTIATED. Regarding the allegation: Staff left residents in soiled clothing. It is alleged that facility staff left resident in soiled clothing for an extended period of time. It was reported that residents in care are left in soiled clothing. Based on LPA’s interview, S#1 revealed that all residents are checked daily and their bed, Six (6) out of Six (6) staff members stated that residents are changed daily, their clothes and diaper are well as needed based on daily checks. Six (6) out of Six (6) staff members when they observe urine on resident clothes or beddings, they (staff) change them and give them showers. Interviews with Six (6) of out of Thirty-Seventh (37) residents revealed no resident are left in soiled clothing for an extended period of time. LPA conducted a record review which confirmed Residence and Care Agreement, Needs and Services Plan, Hospice information and Physician Report for Residents, time sheets, MARs log, Shower log on file. At 02:15 pm LPA observed records of Resident #1-#6 (R1-6). Based on interviews with R3, R2, R1 and R6 and Administrator it was verified that R1-6 do receive showers and are checked daily by staff members. Based interviews with S1-S6 LPA verified that S3 has been providing care to residents in care and manages caregivers’ daily supervision. Regarding the allegation: Staff are not assisting residents with transfers. The complainant claims staff do not assist with transfer of residents. LPA interviewed Six (6) of out of Thirty-Six (36) residents about care for diaper changes, bathing, or transfer to a wheelchair and with overall care process with the resident’s needs. According to the complainant, residents in care are not provided with daily living (ADLs)/transfers. LPA interviewed Five (5) of out of Thirty-Six (36) residents who disagreed with the allegation, and the Department conducted a telephone interview S#2. Six (6) out of Six (6) staff members stated the facility provides adequate care and supervision. Six (6) out of Six (6) staff members do not feel any of the residents rights have been violated while in care.Interviews with Six (6) out of Six (6) staff members primary caregivers and med-tech for residents in care, and six (6) of out of Thirty-Six (36) residents verified that resident are provided help in rooms if needed. On 12/13/2023 between 4 pm – 4:20 pm, the Department interviewed private caregiver representatives for residents in person. One (1) out of One (1) witness (W1) reported the facility is very much involved in the care and supervision of residents. W1 stated they were new to the facility, two months or so, and W1 was proactive in notifying the responsible parties about their resident in care at the facility. W1 stated their resident in care did not need support with transfers of any kind. Continued on LIC-9099C
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David EspanaTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 11-AS-20231205153025
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 SUITES
FACILITY NUMBER: 198320302
VISIT DATE: 12/13/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
During this investigation, LPA did not find sufficient evident to support the above-mentioned allegations. Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has noy been met; therefore, the above-mentioned allegation.

Regarding the allegation: Staff not allowing residents to leave the facility. During this investigation, LPA interviewed Six (6) of out of Thirty-Six (36) residents and interviewed Six (6) out of Six (6) staff members and One (1) out of One (1) witness (W1) and found there is no evidence to support the allegation mentioned above. An interview with Six (6) of out of Thirty-Six (36) residents stated they can leave the facility independently. Six (6) of out of Thirty-Six (36) residents reported that the facility's house rules require for residents must sign in and out at the front desk. Six (6) of out of Thirty-Six (36) residents claimed they follow the rules and do not ignore the signs and the register book when they leave the premises. Six (6) of out of Thirty-Six (36) residents stated they are aware of the house rules and must notify the office staff when they do not return to the facility on the same day. Interviews with Six (6) out of Six (6) staff members all reported that resident are aware of the facility's house rules and that is recommended that if a resident is not returning the same day, the resident must call and notify the office staff. Six (6) out of Six (6) staff members claimed it is preferred that residents do not leave the facility after 10 pm as the facility conducts daily rounds to verify for resident headcounts. Six (6) out of Six (6) staff members stated it is standard to report a missing person after 48 hours according to local law enforcement. Six (6) out of Six (6) staff members stated they, the facility would submit an incident report to Community Care Licensing to notify any residents or public guardian by telephone of any incident.

Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated.



No deficiencies were cited, an exit interview was conducted, and a copy of this report was provided to Muriel Cabacugan Asst Administrator.
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David EspanaTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4