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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601591
Report Date: 07/25/2022
Date Signed: 07/25/2022 12:10:10 PM


Document Has Been Signed on 07/25/2022 12:10 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754



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: 6DATE:
07/25/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Mlcaraz, AdminsitratorTIME COMPLETED:
12:15 PM
NARRATIVE
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On 07/25/2022, Licensing Program Analysts (LPA's) Stephanie Cifuentes and Perry Scott conducted a case management visit at this facility. LPA's met with administrator Mona Alcaraz and explained the purpose of today’s visit is to issue a citation.

During pre-licensing inspection on 7/25/2022 for a change of ownership, LPA CIfuentes observed one Bathrooms 1-bathroom 6 as well as kitchen sink had water temperatures ranging from 123.2F to 143.2F. Deficiencies cited under the California Code Regulations (CCR) Title 22, chapter 6 on attached 809-D.

An exit interview was conducted and a copy of this report and appeal rights were provided to staff Mona Alcaraz.
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie CifuentesTELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:
DATE: 07/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/25/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/25/2022 12:10 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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


FACILITY NAME: BENTLEY HOUSE
FACILITY NUMBER: 198601591

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/25/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/26/2022
Section Cited

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Maintenance and Operation
Faucets used by residents for personal care...shall deliver hot water. Hot water temperature controls shall be maintained... a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degrees C)
This requirement is not met as evidenced by:
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Based on observation, the water temparture for Bathroom #1-Bathroom #6 was between 123.2F and 143.2 F. This poses an immediate health and safety risk to residents 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: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie CifuentesTELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:
DATE: 07/25/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/25/2022
LIC809 (FAS) - (06/04)
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