198320303-8-24-2022-11-AS-MVAO-CLMVSA-20221129154113

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320303
Report Date: 08/23/2022
Date Signed: 08/24/2022 09:55:33 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
08/15/2022 and conducted by Evaluator Pamela Bunker

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20220815165657

FACILITY NAME:	BENTLEY HOUSE		FACILITY NUMBER:	198320303
ADMINISTRATOR:	ALCARAZ, MONA M		FACILITY TYPE:	740
ADDRESS:	3449 ROSEWOOD AVENUE		TELEPHONE:	(213) 478-0460
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90066
CAPACITY:	6	CENSUS: 6	DATE:	08/23/2022
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Lily Belle Calzado		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Facility staff failed to follow physicians orders

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on Tuesday, August 23, 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 staff Lily Belle Calzado. LPA Bunker explained the purpose of today's visit.

The investigation consisted of the following: Interviews conducted with staff 1-2 (S1-S2) and residents (R2-R4) stated staff is following the physician's orders. Residents 5-6 (R5-R6) were sleeping and is on hospice. R1 stated she is handling her own medication. LPA Bunker was unable to interview R5-R-6. S1-S2 stated that R1 was prescribed a new medication by her doctor. Staff stated they are providing R1 with a meal 30 minutes before taking her medication. S1-S2 stated they did not fail to follow the doctor's order.

See continued LIC9099-C page 2

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 213-1113
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2022

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-20220815165657

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 HOUSE	FACILITY NUMBER: 198320303
	VISIT DATE: 08/23/2022

NARRATIVE

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Continued LIC9099-C page 2

Allegation: Facility staff failed to follow physicians orders
Staff 1-2 (S1-S2) and residents (R2-R4) stated staff is following the doctor's orders. S1-S2 stated that R1 was prescribed a new medication by her doctor. S1-S2 stated they are providing R1 with a meal 30 minutes before taking her medication. S1-S2 stated they are not failing to follow the doctor's order. S1-S2 stated they provided R1 with food before taking the medication. S1-S3 stated that R1 is not having any huge side effects. S1-S2 stated R1 will complain about everything. S1-S2 stated R1 want staff to stop assisting other R1 and assist her immediately. S1-S2 stated staff is providing residents with the necessary care and supervision to meet the resident's needs and services as specified according to their physician's directions.

Investigation revealed the following: S1-S2 stated that once ordered by the physician the medication is given according to the physician's directions to all residents. However, R1 refused to allow staff to dispense medication. S1-S2 stated R1 was given a new medication for 2 weeks. S1-S2 stated that R1 is provided food before taking her medication. S1-S2 stated on August 05, 2022, R1 provided staff with a written notice stating beginning Saturday, August 06, 2022, she will administer her medication and doesn’t need any assistance from the facility staff. R1 stated she is handing her medication. R1 stated she fell asleep, forgot to set her timer, staff did not wake her up, and she didn't take her medication at the required time. R1 stated she did not have any side effects from taking the medication later. R2-R4 stated staff is following their doctor's orders. LPA Bunker was unable to interview residents 5-6 (R5-R6) they were asleep and is on hospice. S1-S2 stated the allegation is false and they are following the doctor's orders. S1-S2 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.

There were no deficiencies cited.

Exit interview conducted.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 213-1113
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2022

LIC9099 (FAS) - (06/04)

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