198320302-12-14-2022-11-AS-SCIS-CVLSUH-20230912141104

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320302
Report Date: 12/13/2022
Date Signed: 12/14/2022 08:32:53 AM

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
12/06/2022 and conducted by Evaluator Pamela Bunker

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20221206083610

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
		UNANNOUNCED	TIME BEGAN:	09:53 AM
MET WITH:	Robin Aquino		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Facility issued an unlawful eviction to resident in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on December 13, 2022. 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 Regional Facility Director Robin Aquino. LPA Bunker explained the purpose of today's visit.

The investigation consisted of the following: LPA Bunker interviewed staff 1-2 (S1-S2) and residents (R1-R3). LPA Bunker asked questions relevant to the nature of the complaint. 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

Substantiated

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: 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.

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20221206083610

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: 12/13/2022

NARRATIVE

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Continued LIC9099-C page 2

Allegation: Facility issued an unlawful eviction to resident in care
Staff 1-2 (S1-S2) were interviewed regarding the alleged illegal unlawful eviction. S2 Regional Facility Director Robin Aquino stated R1 received a 30-day eviction notice because he failed to follow house rules. S2 stated he had limited knowledge of the eviction and referred LPA Bunker to Regional Facility Director Robin Aquino. R1 stated that the facility served him a 30-day eviction notice on 11/29/2022, for failure to comply with general hygiene requirements and failure to comply with verbal abuse rules and guidelines. R2-R3 stated they were never served an unlawful eviction.

Investigation revealed the following:
LPA Interviewed staff 1-2 (S1-S2), and residents 1-3 (R1-R3). S1 Ms. Aquino stated R1 was issued a 30-day eviction notice on November 29, 2022, for non-compliance with facility house rules. R1 failed to comply with general hygiene requirements. R1 failed to comply with the health and safety of other residents at the property. R1 failed to comply with verbal abuse and guideline at the facility. Ms. Aquino admitted she did not report the 30-day eviction to Community Care Licensing (CCL) office. LPA reviewed Community Care Licensing records and there was no record of the eviction notice being sent. CCL never received a copy of the Eviction Notice as required by Title 22 Regulations.

Based on LPA’s observations, interviews that were conducted, 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.

Appeal Rights were discussed, and copies of the Complaint Investigation Report LIC9099, LIC9099-C, and LIC9099-D were provided to Staff Terrance Richards.

Exit interview conducted

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 213-1113
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

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20221206083610

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: 12/13/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 12/20/2022 Section Cited CCR 87224(c)(d)(1)	1 2 3 4 5 6 7	87224 Eviction Procedures The licensee shall, in addition to either serving the required thirty (30) days notice , sixty (60) days notice or seeking approval from the Department and service three (3) days notice on the resident, notify or mail a copy of the notice to quit to the resident's responsible person.	1 2 3 4 5 6 7	The licensee will review Title 22 Regulations, Section 80068.5, Eviction Procedures, and submit a written plan on how 30-day or 3-day evictions will be handled according to the Title 22 Regulation requirement in the future. The licensee will submit a plan of correction to CCL office by the POC due date of 12/20/2022.
	8 9 10 11 12 13 14	Resident 1 was issued an eviction notice on 11/29/2022, however, the facility failed to submit a copy of the 30-Day Eviction notice with reasoning for eviction to the Community Care Licensing office as required by Title 22 Regulations. The violation poses a potential health and safety risk to residents in care.	8 9 10 11 12 13 14
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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: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 213-1113
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022

LIC9099 (FAS) - (06/04)

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