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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320302
Report Date: 04/09/2026
Date Signed: 04/09/2026 10:40:06 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/06/2026 and conducted by Evaluator Felisa Shirley
COMPLAINT CONTROL NUMBER: 11-AS-20260106132133
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: 37DATE:
04/09/2026
UNANNOUNCEDTIME BEGAN:
09:48 AM
MET WITH:Muriel Cabacungan, Assistant AdministratorTIME COMPLETED:
10:45 AM
ALLEGATION(S):
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Licensee did not maintain the liability insurance coverage requirements
INVESTIGATION FINDINGS:
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On 4/9/26, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced visit to this facility. LPA was met by the Administrator, Belen Taico and explained the purpose of the visit is to investigate and deliver findings for the allegations mentioned above. LPA was granted access to the facility.

The investigation consisted of the following:
On 1/15/26 LPA Shirley reviewed copies of the following records: Staff and Resident Roster, a copy of the Certificate of Liability Insurance and a Copy of Professional and General Liability Insurance Policy, issued 8/26/25.


Con'd on 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026
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 3
Control Number 11-AS-20260106132133
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: BENTLEY SUITES
FACILITY NUMBER: 198320302
VISIT DATE: 04/09/2026
NARRATIVE
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The investigation revealed the following:

Allegation: Licensee did not maintain the liability insurance coverage requirements

It is being reported that this facility does not have the proper liability insurance that is required. On 4/7/26, LPA Felisa Shirley reviewed the Certificate of Liability Insurance provided for Bentley Suites. Per the certificate, the effective date of coverage is 08/26/2026 thru ending date of 8/26/2026. This certificate indicates the coverage of limits one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate. However, this certificate states that this policy has sublimit in the categories of Bed Sore & Elopement, with 100,000 per occurrence and 300,000 being the maximum. A copy of the full Professional and General Liability Insurance Policy for Residential Care Facility was requested and received by the department on 3/30/2026. Per the full policy, one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate are covered, but there is a 10,000 deductible as well as sublimit of $100,000 per claim and 300,00 per yearly occurrence in the categories of Physical and Sexual Abuse, Elopement, Bedsores, Fall Hazards and an added Medical Payment Sublimit of $5,000 per claim, meaning this policy does not provide the required coverage of one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate for this facility.


LPA interviewed staff 1 and staff 2 (S-1 and S-2). Of those interviewed 2 out of 2 denied the allegation.


Based on interviews and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division 6, and Chapter 8 are being cited on the attached LIC9099-D.

A deficiency is being issued and an exit interview is conducted with Muriel Cabacungan, Assistant Administrator. A copy of this report and appeal rights were provided.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20260106132133
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: BENTLEY SUITES
FACILITY NUMBER: 198320302
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/09/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/16/2026
Section Cited
HSC
1569.605
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Liability insurance… all residential care facilities for the elderly … shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate, caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees.

This requirement was not met as evidenced by:
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Licensee stated they will obtain liability insurance that complies with Health & Safety Code section 1569.605 and submit proof to LPA Felisa Shirley by POC due date of 4/15/26 by email, Attn: LPA Felisa Shirley at felisa.shirley@dss.ca.gov or fax to 424-544-1016.
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Based on records reviewed, the Licensee did not maintain required liability insurance from 8/26/25 to 8/26/26 which includes a break down of the limits of liability which poses an immediate safety risk and personal rights risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026
LIC9099 (FAS) - (06/04)
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