198601591-2-9-2022-11-AS-JHAD-CEHTJP-20220517144640

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601591
Report Date: 02/09/2022
Date Signed: 02/09/2022 03:37:18 PM

Substantiated

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
02/04/2022 and conducted by Evaluator Ulysses Coronel

COMPLAINT CONTROL NUMBER: 11-AS-20220204111404

FACILITY NAME:	BENTLEY HOUSE		FACILITY NUMBER:	198601591
ADMINISTRATOR:	BIOSEH OGBECHIE		FACILITY TYPE:	740
ADDRESS:	3449 ROSEWOOD AVE		TELEPHONE:	(213) 478-0800
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90066
CAPACITY:	6	CENSUS: 5	DATE:	02/09/2022
		UNANNOUNCED	TIME BEGAN:	11:04 AM
MET WITH:	Mona Alcaraz and Lilybelle Calzado		TIME COMPLETED:	03:50 PM

ALLEGATION(S):

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Illegal Eviction

INVESTIGATION FINDINGS:

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On 02/09/2022 Licensing Program Analyst (LPA) Ulysses Coronel conducted an unannounced Complaint Visit to initiate the investigation on the above-mentioned complaint allegation. LPAs spoke to the administrator Mona Alcaraz and met with Lead Staff, Lilybelle Calzado and the purpose of today's visit was explained.

The investigation consisted of the following. On 2/7/22 LPM Hammond interviewed R1, the facility Administrator Mona Alcaraz and Corporate Office Staff Joe Chen. On 2/9/22, LPA Coronel reviewed R1 record and obtained copies of R1 (Needs & Service Plan, Admission Agreement, Physicians Report, SIR's and all eviction notices and correspondences).

The investigation revealed the following: It is alleged that facility staff is evicting Resident #1 (R1). Community Care Licensing received and reviewed a copy of the eviction notice served to R1 on 1/5/2022. Review of the eviction notice revealed R1 is being evicted “Due to resident not being a good fit for Bentley House”.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ulysses Coronel	TELEPHONE: (951) 212-8917
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022

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-20220204111404

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: 02/09/2022

NARRATIVE

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On 2/7/22, LPM Hammond interviewed R1 regarding the allegation. R1 stated she was served an eviction notice, but the eviction should have been served to the hospital as they placed and was paying for her stay. R1 stated she was never assessed prior to moving in the facility to determine if the facility could properly care for her. On 2/7/22, LPM Hammond interviewed Administrator Mona Alcaraz via telephone regarding the allegation. The Administrator stated a 30-day eviction was served to R1 in January, but she was unable to provide detail on the residents eviction stating LPM would need to call and speak with the corporate office. On 2/7/22, LPM Hammond spoke with Joe Chen, Corporate Office regarding the eviction. Joe stated R1 was served a 30-day notice on 1/5/2022 and on 2/7/22 R1 was given a 3 day notice to pay the rent. Joe stated the purpose of R1 eviction is due to R1 not being a good fit. LPM Hammond inquired if R1 was reassessed prior to the eviction notice and Joe was unsure if this was completed. On 2/9/22, LPA Coronel reviewed R1's record and did not observe a document reassessment in the file. Regarding the allegation "Illegal Eviction": Based on records reviewed, information received and interviews conducted the facility staff illegally eviction R1, The facility failed to issue an eviction in accordance with Title 22 Regulations 87224 Eviction Procedures, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D. Failure to correct may lead to assessment of civil penalties.

An exit interview was conducted and plan of corrections developed. A copy of this report and appeals rights were provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ulysses Coronel	TELEPHONE: (951) 212-8917
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20220204111404

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: 02/09/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/11/2022 Section Cited CCR 87224(a)(4)	1 2 3 4 5 6 7	87224(a)(4) Eviction Procedures. The licensee may evict a resident...(5). Thirty (30) days written notice to the resident is required...(5).If, after admission, it is determined that the resident has a need not previously identified and a reappraisal has been conducted pursuant to Section 87463, ... resident.	1 2 3 4 5 6 7	The Administrator agreed to rescind the 30 day eviction notice 01/05/2022 for resident R1 Administrator to provide R1 with a letter rescinding the 30 day eviction proof of correction will be submitted to CCL by POC Due Date.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: Based on interviews and record reviews the licensee failed to ensure that a reappraissal was conducted pursuant to Section 87463 which poses a potential health and safety risk to resident in care.	8 9 10 11 12 13 14	Failure to correct may result to assessment of Civil Penalties.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ulysses Coronel	TELEPHONE: (951) 212-8917
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022

LIC9099 (FAS) - (06/04)

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