198320303-11-4-2022-11-AS-UCOL-CLNM4V-20221130081719

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320303
Report Date: 11/04/2022
Date Signed: 11/04/2022 01:43:47 PM

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
09/15/2022 and conducted by Evaluator Don Senaha

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20220915154115

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	CENSUS: 4	DATE:	11/04/2022
		UNANNOUNCED	TIME BEGAN:	12:55 PM
MET WITH:	Lead Caregiver - Lilybelle Calzado		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff did not safeguard resident's personal property.
Staff are not meeting residents needs.

INVESTIGATION FINDINGS:

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On 11/4/22 Licensing Program Analyst (LPA) Don Senaha initiated a subsequent complaint investigation for the allegations listed above to deliver findings. Today’s complaint investigation was conducted at the facility with Lead caregiver Lilybelle Calzado.

On 09/21/2022 Licensing Program Analyst (LPA) Don Senaha initiated an initial complaint investigation for the allegations listed above. Today’s complaint investigation was conducted at the facility with Lead caregiver Lilybelle Calzado.

LPA interviewed clients (R1-R4). Resident (R5) was unable to interview at the time. LPA interviewed staff (S2-S3) and staff (S1) the Licensee on the phone. LPA obtained pertinent documents.
A plant inspection of the facility was conducted during both visits.

No deficiencies were found at the time of the visit.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Don Senaha	TELEPHONE: (323) 629-5133
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2022

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-20220915154115

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: 11/04/2022

NARRATIVE

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Investigation revealed:

Allegation: Staff did not safeguard resident’s personal property

During the course of investigation, LPA was unable to find any evidence supporting the allegation. Three (3) of the four (4) residents interviewed stated staff has access to their room when residents are not present but have no issues with staff entering their rooms. Three (3) of the four (4) residents stated there are no issues with belongings or personal property missing from resident’s rooms. Administrator stated there are no reports of missing personal property from resident’s rooms. Staff (S2-S3) stated residents four (4) of the five (5) residents have not claimed missing personal property from resident’s room. Staff (S3) stated staff does not go into resident (R1) room to clean unless (R1) is present per (R1) request. Staff (S3) stated staff closes (R1) door and does not enter the room until (R1) is present when (R1) leaves the facility. LPA observed resident (R1) room to be crowded with boxes of various items open and unopened during visit.

There is no evidence that supports the allegation the facility does not safeguard resident’s personal property.

Allegation: Staff are not meeting residents needs.

During the course of investigation, LPA was unable to find any evidence supporting the allegation. Three (3) of the four (4) residents interviewed stated there are no issues with staff not meeting resident’s needs. Three (3) of the four (4) residents interviewed stated to call for staff assistance the residents push the call button or call staff’s name. Three (3) of the four (4) residents interviewed stated there are no issues with response from staff when calling for help. Administrator stated residents have the call button to get assistance. Administrator stated staff responds immediately to the call button. Administrator stated mobility devices are within reach of the residents. Staff (S2-S3) stated residents push the call button for assistance. Staff (S2-S3) stated staff responds immediately to call button unless staff is assisting another resident. Staff will notify available staff to assist. Staff (S2-S3) stated mobility devices are within reach of the residents. LPA observed no issues with the positioning of mobility devices in resident’s rooms at the time of the visit. LPA observed these mobility devices to be in reach of each resident in resident’s rooms. LPA observed the call button being responded to by staff several times during the investigation at the facility.

There is no evidence that supports the allegation the staff are not meeting residents needs.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Don Senaha	TELEPHONE: (323) 629-5133
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2022

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20220915154115

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: 11/04/2022

NARRATIVE

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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 Lead caregiver Lilybelle Calzado and a hard copy was provided.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Don Senaha	TELEPHONE: (323) 629-5133
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2022

LIC9099 (FAS) - (06/04)

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