198320303-1-5-2024-11-AS-MVAO-CZCQD8-20240110110420

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320303
Report Date: 01/05/2024
Date Signed: 01/05/2024 11:30:03 AM

Unsubstantiated

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
09/29/2022 and conducted by Evaluator Elvira Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20220929171846

FACILITY NAME:	BENTLEY HOUSE		FACILITY NUMBER:	198320303
ADMINISTRATOR:	ALCARAZ, MONA M		FACILITY TYPE:	740
ADDRESS:	3449 ROSEWOOD AVENUE		TELEPHONE:	(310) 398-6264
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90066
CAPACITY:	6; 6	CENSUS: 5	DATE:	01/05/2024
		UNANNOUNCED	TIME BEGAN:	10:35 AM
MET WITH:	Lilybelle Calzado		TIME COMPLETED:	11:35 AM

ALLEGATION(S):

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Facility is not providing adequate activities for residents.
Staff are not properly trained to provide for the needs of residents.

INVESTIGATION FINDINGS:

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On 1/5/24, Licensing Program Analyst (LPA) Elvira Gonzalez conducted a subsequent complaint visit to deliver the complaint findings. Upon arrival, LPA met with Lilybelle Calzado and explained the purpose of the visit.

The investigation consisted of the following: On 10/3/2023, LPA toured the inside and outside grounds of the facility. LPA requested and obtained copies of Staff Roster, Resident Roster, Activity Calendar, Resident #1's service records (Admission Agreement, Appraisal, and Physician's Report) and staff training records. LPA interviewed two staff (S1-S2), two (2) residents (R1-R2) and one (1) witness (W1).

Report continued in LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Elvira Gonzalez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2024

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-20220929171846

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 HOUSE	FACILITY NUMBER: 198320303
	VISIT DATE: 01/05/2024

NARRATIVE

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Investigation revealed the following:

Allegation: Facility is not providing adequate activities for residents.

It was alleged that there are no social activities in the facility. On 10/3/2023 from 10:00 am – 11:45 am, LPA Montoya interviewed two staff (S1-S2), two (2) residents (R1-R2) and one (1) witness (W1). LPA attempted to interview two residents (R3-R4) but LPA was unable to obtain statements due to the residents’ medical conditions. Based on interviews with S1 and S2, the facility has scheduled activities but not all residents are willing to participate. The facility offers the following activities: board games, play card, coloring, shooting balls, music hour, watching TV, and many others. The residents are reminded daily to participate in these activities. Interview with R1 and R2 revealed they prefer their own activities. R1 prefers to listen to the radio, watch TV in the bedroom and shop online. R2 is not interested in the facility activities but prefers to go out to the community with a friend. Interview with one witness (W1) revealed W1 is uncertain whether there are activities offered in the facility. LPA observed play balls, word puzzles, arts and craft and board games in the living room. Based on record review, the facility has an activity calendar that offers adequate activities, however, LPA observed based on interviews that residents prefer their own personal activities. Based on observations, interviews and record review, there is no sufficient evidence to prove the above allegation.

Report continued in LIC9099-C

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Elvira Gonzalez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2024

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20220929171846

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 HOUSE	FACILITY NUMBER: 198320303
	VISIT DATE: 01/05/2024

NARRATIVE

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Allegation: Staff are not properly trained to provide for the needs of the residents.

It was alleged that there are two brand new employees in the facility who are totally untrained. These staff are not unwilling to assist but staff just don’t know how to do things. On 10/3/2023 from 10:00 am – 11:45 am, LPA Montoya interviewed two staff (S1-S2), two (2) residents (R1-R2) and one (1) witness (W1). LPA attempted to interview two residents (R3-R4) but LPA was unable to obtain statements due to the residents’ medical conditions. Based on interviews with S1 and S2, they had training prior to working at the facility. S1 and S2 stated they also had on-the- job training. S1 and S2 stated all staff are fully trained to provide for the needs of residents. Interviews with one resident (R2) and a witness (W1) revealed staff are properly trained to provide for the needs of the residents and all staff are able and willing to assist residents. R1, however, claimed that staff are willing to assist but two staff are not properly trained to provide for the needs of the residents. LPA observed the two on duty staff (S1-S2) were properly assisting residents in care. Based on observations, interviews and record review, there is no sufficient evidence to prove the above allegation.

Based on LPA’s interviews conducted and records reviews, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

An exit interview was conducted with Lilybelle Calzado and a hard copy of the report was provided.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Elvira Gonzalez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2024

LIC9099 (FAS) - (06/04)

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