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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320302
Report Date: 06/08/2023
Date Signed: 06/08/2023 03:02:06 PM

Substantiated


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
06/02/2023 and conducted by Evaluator Jose Calderon
COMPLAINT CONTROL NUMBER: 11-AS-20230602161814
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: 33DATE:
06/08/2023
UNANNOUNCEDTIME BEGAN:
09:58 AM
MET WITH:STAFF HAZEL LUGUEVARRATIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff does not ensure that the facility provides a safe and sanitary environment for the residents.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to Bentley Suites facility on 06/08/2023 and was greeted by Staff Hazel Luguevarra (S1). LPA Calderon spoke to S1 prior to entering the facility to conduct a risk assessment. LPA Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations.

During this investigation, LPA Calderon interviewed A1, S1 and interview R1-R3. These interviews were conducted on 06/08/2023. On 06/08/2023 LPA Calderon requested copies of the following: Staff and Resident rosters, pest control reports for April and May 2023, permit from the City of Santa Monica for pigeons kept over (12 animals) plan of operation (addendum) to have animals on property. On 06/08/2023 LPA Calderon toured the common areas and pigeon coup with S1

The investigation revealed the following:
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2023
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-20230602161814
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: 06/08/2023
NARRATIVE
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The alleged facility staff did not provide a safe and sanitary environment for residents. On 06/08/2023 LPA Calderon interviewed A1 for complaint. A1 relays that the facility does not have a permit from the city of Santa Monica to have 12 or more pigeons. A1 relays that the facility did not ask for a change in their plan of operations to have animals on the property from department of social services. A1 relays that the residents love the pigeons, but A1 does understand that the pigeons flying around is not sanitary for staff or residents. On 06/08/2023 LPA Calderon interviewed S1 for complaint. S1 relays that the residents love having the pigeons around and that the facility has had the pigeons for over 1 year. S1 relays that staff cleans the grounds 2 times per day. S1 relays that the pigeons fly around all day and S1 did not notice that pigeon poop could and did get on resident’s wheelchair wheels and could get on residents’ hands and face. On 06/08/2023 LPA Calderon interviewed R2-R3 for complaint. R2-R3 relay that the pigeons attract flies and relay that the pigeons fly all over the facility grounds landing on tables, chairs and walk all over the grounds. S2-S3 relay that they love the pigeons but that the pigeon poop gets on their wheelchair wheels and then on their hands when they touch their wheels to move. On 06/08/2023 LPA Calderon and S1 toured the facility. LPA Calderon noticed that there were more than 12 pigeons in the facility up to 30 pigeons in total. LPA Calderon notice that pigeons were flying all over the facility and could be found in the roof of the building, on the ground and walking around. LPA Calderon also notice 2 pigeons walk into the dining room area. LPA Calderon noted the facility was clean, but near that pigeon coop there was poop on the ground. LPA Calderon also noted 2 residents had pigeon poop on their wheels from rolling on the ground. LPA Calderon also notice many flies around the pigeon coop and flying inside the dining room area.

Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has been met; therefore, the allegation of “staff does not ensure that the facility provides a safe and sanitary environment for the residents” is found to be SUBSTANTIATED.



An exit interview was conducted and copy of the Complaint Report and Appeal Rights were provided to the Staff Hazel Luguevarra (S1).
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20230602161814
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/08/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/16/2023
Section Cited
CCR
87303(A)
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87303 Maintenance and Operation.(A)The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by:
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Plan of correction, Administrator will move alll pigeons off the facility property by 06/16/2023 and will provide LPA Calderon with written proof of same.
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Based on interviews, observations and records the licensee failed to provide CDSS with a addendum to the facility plan of operation and failed to control the movement of 30 pigeons or clean the pigeon fecies. This poses a potential health & safety 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.
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3