198320303-11-14-2022-11-AS-JHAD-CM3SU7-20221213131041

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320303
Report Date: 11/14/2022
Date Signed: 11/14/2022 02:26:02 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
11/08/2022 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20221108111748

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: 5	DATE:	11/14/2022
		UNANNOUNCED	TIME BEGAN:	09:02 AM
MET WITH:	LillyBelle Cazado		TIME COMPLETED:	02:47 PM

ALLEGATION(S):

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Facility staff stole residents belongings.
Facility staff is withholding residents mail.

INVESTIGATION FINDINGS:

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On 11/14/22, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced visit to the facility and was greeted by lead caregiver Lilybelle Calzado staff #1 (S1). LPA explained the purpose of this visit is to investigate the allegations mentioned above.

The investigation consisted of the following: LPA initiated an investigation for the above-mentioned allegations. Interviews with staff #1-#4 (S1-S4), resident #1-#6 (R1-R5) and witness #1 (W1). LPA requested copies of the following: staff and resident rosters, (R1’s) physician’s report, appraisal/needs and services plan and other documents associated with this complaint.

Evaluation Report continues LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 11/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2022

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-20221108111748

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: 11/14/2022

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Facility staff stole residents belongings.
Facility staff is withholding residents mail.
The details of the complaint state resident #1 (R1's) personal belongings were stolen and that mail is being withheld by staff. The complainant claims the facility stole (R1's) vitamins/supplements and prescription medications. (R1) was a resident at this facility from 08/12/21 through 10/20/22. As of 10/21/22, (R1) is now a former resident and no longer resident at this facility. The Department interviewed (R1) who currently resides at a skilled nursing facility (SNF) who stated not receiving all vitamins/supplements as well as prescribed medications during the transition. (R1) stated during the move, (R1) was not involved in with process and did not observe what belongings were packed, stored, or transported. (R1) was not certain if the personal belongings were stolen by staff. (R1) stated, "it was not a malicious act". Interviews with staff #1 - #3 (S1-S3) dispute this claim. (S1-S3) stated (R1) self-medicated and stored all medications including vitamins/supplements to prevent staff from accessing them. (S1-S3) reported (R1) was present throughout the entire transition process. Caregiver staff #3 (S3) reported (R1), observed, and directed what belonging would be packed, stored, and moved. (S1-S3) reported there were about 30 boxes that were stored in personal storage leased by (R1). According to (S2-S3), (R1) was limited on what personal items were allowed at the (SNF) and left some bags of vitamins/supplements in storage and several bags went with (R1) to SNF. (S1-S2) had an agreement signed by (R1) dated 10/19/22 stated the following prescribed medications: Loperamide, Capecitabine, Ondansetron, and Cal-Gest Antacid were in possession with (R1) when she left the facility on 10/20/22. An interview with the social worker (W1) at the (SNF) verified that (R1) was admitted with vitamins/supplements. (R1) did not have any prescribed medications when (R1) was admitted on 10/20/22. Interviews with residents #2-#5 (R2-R5) were complimentary of staff. (R2-R5) stated they had no concerns over their belongings and it is safeguarded by staff.

The complainant alleges the staff has withheld (R1's) mail. An interview with (R1) revealed that a change of address has been implemented with USPS. (R1) claims she did not get to vote during the November election due to no ballot was sent to the new address. An interview with administrator Mona Alcaraz stated (R1) had a verbal agreement that once (R1) is settled at (SNF),
Evaluation Report continues LIC 9099C

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 11/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2022

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20221108111748

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: 11/14/2022

NARRATIVE

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(R1) will call the facility to determine how the mail shall be forwarded. (S2) claims (R1) has not reached out to her and that eight (8) mail items are held. There was no evidence of a 2022 US Ballot held at the facility. Interviews with (R2-R5) stated no issues with personal mail as family members would bring them over during each visit to the facility. Due to a health condition, resident #6 (R6) was unable to hold a conversation and did not participate in an interview.

Based on the information gathered, an inspection of the facility, observation, analysis of (R1's) service records, photographs, videos, written agreements, and interviews conducted, the Department found no evidence to support the allegations mentioned in this complaint

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations, did or did not occur, therefore the allegations are Unsubstantiated.

No deficiencies were cited during this visit.

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

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 11/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2022

LIC9099 (FAS) - (06/04)

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