198320302-1-6-2023-11-AS-WGIS-CMU2PJ-20230106163424

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198320302
Report Date: 12/13/2022
Date Signed: 01/06/2023 04:34:34 PM

Document Has Been Signed on 01/06/2023 04:34 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	BENTLEY SUITES		FACILITY NUMBER:	198320302
ADMINISTRATOR:	AQUINO, ROBIN		FACILITY TYPE:	740
ADDRESS:	851 4TH STREET		TELEPHONE:	(213) 478-0460
CITY:	SANTA MONICA	STATE: CA	ZIP CODE:	90403
CAPACITY:	44	CENSUS: 27	DATE:	12/13/2022
TYPE OF VISIT:	Post Licensing	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Robin Aquino		TIME COMPLETED:	03:30 PM

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On 12/13/22 Licensing Program Analysts (LPA), Wendy Gibbs conducted an unannounced post licensing inspection The capacity is for 44 clients,40 non-ambulatory, 4 bedridden. Currently the facility has 27 residents. LPA met with Licensee/administrator Robin Aquino.
Structure: The facility is a two-story structure located in a residential neighborhood. It consists of the following: twenty two (22) resident rooms with attached baths, lounge, outdoor patio, dining area, kitchen, pantry and laundry room. The client bedrooms are spacious and easily accommodate the client's furnishings.
Physical Plant There is a shaded inner yard with a covered patio, tables and chairs. Outdoor passageways, walkways, driveways, steps and patios are clean and free of obstructions. LPA did not observe hazards, such as ladders, gardening tools and/or motorized equipment in the front, back and/or side areas of the facility. There were bird coops in the patio against the wall. LPA observed no bodies of water.
Bedrooms Residents: LPA inspected 14 resident rooms, all rooms had the required furniture according to occupancy, including beds, dressers, nightstand, lamp, chair and ample closet space.

Bathroom: Facility has 22 client bathrooms and one staff bathroom. LPA inspected 14 bathrooms and found they all have working toilets, wash basins and showers. There are grab rails next to both the toilets and the showers that were securely fastened. All showers had nonskid mats and/or shower chairs. LPA observed adequate lighting in the bathrooms and in the hallways leading to bathrooms.

Linens & Hygiene Supplies: Beds have the required linen/supplies which include, pillowcases, mattress pads, fitted sheet, blanket and bedspreads. Adequate supply of linen and hygiene supplies stored in a first-floor cupboard, second floor cupboard and laundry room. Each resident who requires diapers have an ample supply stored in their closets. All toxins were stored and locked in the laundry room.

Kitchen: All appliances were in good working order. There were 2 refrigerators in the kitchen, one was for staff use only, and an additional refrigerator in the pantry. LPA observed a 4-day supply of perishable foods and a 7-day supply of non-perishable. With an additional Emergency only supply of non-perishable. All cutleries were in good repair. Knives were locked and stored in a cabinet in the kitchen.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 12/13/2022

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Water temperature: Water temperature in kitchen and bathrooms measured between 105.6-118.9 degrees Fahrenheit.

Medications: All medication were centrally stored and locked in a cabinet in the Administrators office. LPA reviewed the medications for 6 residents.

Files: LPA reviewed five (5) resident files, and they contained all the necessary documentation. LPA reviewed four (4) staff files and they contained all the necessary documentation except one CPR expired on 12/03/22 and has not been renewed.

Reading Material, Games, Equipment & Materials: The facility provides puzzles, games, and papercrafts as well as ball toss and bingo. LPA observed activity calendar in the hallway.

Safety LPA observed 6 fire extinguishers throughout the facility that were fully charged and last serviced on May 31, 2022. The resident’s rooms are equipped with a sprinkler system which was serviced in June 2022. All rooms were equipped with smoke detectors that were in good working order. The last emergency drill was on November 9, 2022. Exit plans were posted throughout the facility. Emergency Disaster Plan is posted in the hallway and accessible to all. Emergency numbers were posted and accessible. Doors have auditory deices to monitor exits. LPA inspected the First Aid Kit, which contained all the required items and the manual, it is available to staff and inaccessible to residents. There is a working landline on the premises (office and kitchen).

Infection Control When LPA arrived, temperature was taken and logged on a sign in sheet. All staff were wearing masks. Hand sanitizing stations were at the entrance and through out the facility. Gloves are posted at the entrance of all resident doors. PPEs were available at the check in station. They were conducting a mass Covid testing which they do twice a week. All necessary signs were posted in hallway, common rooms and resident’s rooms.

Deficiencies In rooms 2 and 17, resident’s use oxygen and there is no sign posted outside room. Staff has an expired CPR/1^st aid training (expired on 12/03/22).

An exit interview was conducted with Benji DeCastro and a copy of this report was provided.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022

LIC809 (FAS) - (06/04)

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