198320302-5-21-2023-11-AS-SCIS-CSTTV8-20230615150330

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320302
Report Date: 05/17/2023
Date Signed: 05/21/2023 06:03:18 AM

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
11/07/2022 and conducted by Evaluator Pamela Bunker

COMPLAINT CONTROL NUMBER: 11-AS-20221107161145

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: 33	DATE:	05/17/2023
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Divine Grace Diaz		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff engaged in verbal altercation with resident.
Staff physically bumped resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on Wednesday, May 17, 2023. Upon arrival at the facility. LPA Bunker called the facility via telephone and conducted a Risk Assessment. Based on the assessment, the facility is cleared of COVID-19 infection. LPA Bunker met with Med Tech/Caregiver Divine Grace Diaz . LPA Bunker explained the purpose of today's visit.

The investigation consisted of the following: During the visit course of the investigation LPA Bunker interviewed staff 1-4 (S1-S4) and residents (R1-R4). LPA Bunker asked questions relevant to the nature of the complaint. S1-S4 and R2-R4 stated staff did not engage in a verbal altercation with a resident. S1-S3 and R2-R4 stated staff did not physically bump a resident. LPA Bunker requested and reviewed R1's records. LPA Bunker requested copies of supporting documents. Regional Facility Director Robin Aquino provided LPA Bunker with copies.

See continued LIC9099-C page 2

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 213-1113
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20221107161145

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: 05/17/2023

NARRATIVE

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Continued LIC9099-C page 2
Allegation #1: Staff engaged in a verbal altercation with a resident.
Staff 1-3 (S1-S3) stated none of the staff engaged in a verbal altercation with R1. Staff 4 (S4) stated she was not working at the facility when the complaint allegations were reported. S4 stated she never witness staff in a verbal altercation with any of the residents. S1-S3 stated they advised R1 the staff needed to remove all the items and furniture from out of his room because it was heavily infested with bed bugs, the exterminator was going to treat the room until the bed bugs were completely gone. S1-S3 stated they asked R1 if he wanted to keep any of his items. R1 did not want the staff to remove items from his room. S1-S3 stated they told R1 he could not bring the infested items back to his room. S1-S3 stated R1 got upset and was verbally abusive toward staff. S1-S3 and R2-R4 stated R1 is the person that speaks inappropriately to staff and residents. R2-R4 stated staff never engaged in a verbal altercation with R1. R1-R4 stated staff treats residents with dignity and respect. S1-S4 and R2-R4 denied the allegation.

Allegation #2: Staff physically bumped the resident. Staff 1-4 (S1-S4), and residents 2-4 (R2-R4) all stated residents are treated with dignity and respect. S1-S-4 and R2-R4 stated a male staff did not bump the resident with his stomach during a verbal altercation. S1-S4 and R2-R4 all stated residents are treated with dignity and respect. S1-S4 and R2-R4 denied the allegation.

Investigation revealed the following:
LPA Interviewed staff 1-4 (S1-S4), and residents 2-4 (R2-R4) all stated residents are treated with dignity and respect. S1-S4 stated residents are safe, healthy, and have comfortable accommodations, furnishings, and equipment to meet their needs. S1-S4 stated residents free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature. S1-S4 stated residents do not interfere with the resident's daily living functions, including eating, sleeping, or toileting; or withholding of shelter, clothing, medication, or aids to physical functioning. S1 Ms. Aquino stated R1 failed to comply with the health and safety of other residents at the property. R1 fail to comply with verbal abuse and guideline at the facility. S1-S4 and R2-R4 denied the allegation.

Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed unsubstantiated.
A copy of the Complaint Investigation Report LIC9099 and LIC9099-C provided to the Med Tech/Caregiver Divine Grace Diaz. There were no deficiencies cited. An exit interview was conducted.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 213-1113
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023

LIC9099 (FAS) - (06/04)

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