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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601591
Report Date: 12/07/2021
Date Signed: 12/10/2021 08:47:10 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
12/01/2021 and conducted by Evaluator Ulysses Coronel
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20211201083611
FACILITY NAME:BENTLEY HOUSEFACILITY NUMBER:
198601591
ADMINISTRATOR:BIOSEH OGBECHIEFACILITY TYPE:
740
ADDRESS:3449 ROSEWOOD AVETELEPHONE:
(213) 478-0800
CITY:LOS ANGELESSTATE: CAZIP CODE:
90066
CAPACITY:6CENSUS: 4DATE:
12/07/2021
UNANNOUNCEDTIME BEGAN:
10:16 AM
MET WITH:Mona Alcaraz and Lilybelle CalzadoTIME COMPLETED:
03:02 PM
ALLEGATION(S):
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Facility is in disrepair
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ulysses Coronel and LPA Ngozi Nwaokoro conducted an unannounced complaint visit to initiate the investigation on the above-mentioned complaint allegation. LPAs spoke to the administrator Mona Alcaraz met with Lead Staff, Lilybelle Calzado and the purpose of today's visit was explained.

The investigation consisted of the following: During today’s visit LPAs Coronel and Nwaokoro conducted a tour of the facility, interviewed the administrator, 2 staff, and 4 out of 4 residents. LPAs also reviewed staff and residents’ records.

The investigation revealed the following: Regarding the allegation; “Facility is in disrepair.” 2 out of 4 residents residents R1 and R3 were not available to interview, 1 out of 4 residents did not have any issues with the facility being in disprepair, R4 stated "Its okay." Resident R2 stated that “The circuit breakers kept on blowing-up last month and when this happens it gets cold at night, and some of the medical equipment like the beds that move up and down no longer work."
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ulysses CoronelTELEPHONE: (951) 212-8917
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 11-AS-20211201083611
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: BENTLEY HOUSE
FACILITY NUMBER: 198601591
VISIT DATE: 12/07/2021
NARRATIVE
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Staff S1 stated that “Sometimes the power goes off when we use all of the heaters, specially when the heaters in rooms 2 and 3 are plugged.” S2 stated “When the power turns off it only affects rooms 2, 3 and 6. This usually happens at night.” Regarding the allegation; “Facility is in disrepair.” Based on LPAs observations and interviews which were conducted the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D.

An exit interview was conducted and plan of corrections developed. A copy of this report and appeals rights were provided.
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ulysses CoronelTELEPHONE: (951) 212-8917
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 11-AS-20211201083611
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: BENTLEY HOUSE
FACILITY NUMBER: 198601591
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/07/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/28/2021
Section Cited
CCR
87303(a)
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87303(a) Maintenance and Operation. The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidenced by:
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The administrator agreed to have the facilities ciruit breakers serviced by a technician. The administrator also agreed to create a plan to ensure that the facility is in good repair at all times. Proof of correction will be submitted by POC due date.
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Based on LPA observation and interviews the licensee failed to ensure that the facility is in good repair at all times, the power in rooms 2,3 and 6 turns off when the circuit breaker trips due to multiple space heaters in usem which poses a potential risk to the resdients in care.
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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: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ulysses CoronelTELEPHONE: (951) 212-8917
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
12/01/2021 and conducted by Evaluator Ulysses Coronel
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20211201083611

FACILITY NAME:BENTLEY HOUSEFACILITY NUMBER:
198601591
ADMINISTRATOR:BIOSEH OGBECHIEFACILITY TYPE:
740
ADDRESS:3449 ROSEWOOD AVETELEPHONE:
(213) 478-0800
CITY:LOS ANGELESSTATE: CAZIP CODE:
90066
CAPACITY:6CENSUS: 4DATE:
12/07/2021
UNANNOUNCEDTIME BEGAN:
10:16 AM
MET WITH:Mona Alcaraz and Lilyvelle CalzadoTIME COMPLETED:
03:02 PM
ALLEGATION(S):
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Food quality is poor.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ulysses Coronel and LPA Ngozi Nwaokoro conducted an unannounced complaint visit to initiate the investigation on the above-mentioned complaint allegation. LPAs spoke to the administrator Mona Alcaraz met with Lead Staff, Lilybelle Calzado and the purpose of today's visit was explained.

The investigation consisted of the following: During today’s visit LPAs Coronel and Nwaokoro conducted a tour of the facility, interviewed the administrator, 2 staff, and 4 out of 4 residents. LPAs also reviewed staff and residents’ records.

The investigation revealed the following: Regarding the allegation; "Food quality is poor." during todays visit LPA Coronel toured the facility and observed one week's supply of nonperishable foods and two days supply of perishable foods being maintained at the facility. During interiviews 2 out of 4 residents residents R1 and R3 were not available to interview, 1 out of 4 residents R4 declined to answer. Resident R2 stated that “The quality of the food is not good. I told staff what I like and sometimes they would not prepare the food as I requested. They keep on serving general branded food and white bread instead of 100 percent whole wheat."
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ulysses CoronelTELEPHONE: (951) 212-8917
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 11-AS-20211201083611
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: BENTLEY HOUSE
FACILITY NUMBER: 198601591
VISIT DATE: 12/07/2021
NARRATIVE
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Staff S1 stated "We ask R2 what they like to eat almost daily, I try to cook for R2 to make R2 happy, since R2 was formerly in the catering business they have a very different standard when it comes to food. S2 stated "S1 cooks very well and serves good quality food to the residents." Regarding the allegation"Food quality is poor." 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 unsubstantiated.

An exit interview was conducted. A copy of this report was provided.
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ulysses CoronelTELEPHONE: (951) 212-8917
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 5