<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601591
Report Date: 09/22/2021
Date Signed: 09/22/2021 11:27:30 AM

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
MONTEREY 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: 4DATE:
09/22/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:37 AM
MET WITH:Lilyville Calzado, Lead StaffTIME COMPLETED:
11:30 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Jennifer Jones conducted an unannounced Plan of Correction (POC) visit to this facility Bentley House. LPA arrived and met with Lilyvelle Calzado, Lead Staff. LPA explained the reason for the visit.

LPA toured the facility and followed up on the POC for a citations that was issued during a previous visit. During the visit, LPA spoke with Resident 1 and Lead Staff, Lillyville Calzado provided LPA with a updated copy of the activity calendar. Lead Staff, Lilyville advised LPA with an update on different ways the staff has been encouraging residents to come out of their rooms.
LPA cleared citations 87219(a)(1)-(6) Planned Activities and 87468.2(a)(1) Additional Personal Rights of Residents in Privately Operated Facilities during the visit.

LPA followed on citation 87506(a) given during the last visit. Staff advised that the admission agreements are still at the corporate office.
Based on record review, the facility failed to meet the POC due date of 09/21/21 for citation 87506(a).

Civil Penalties are being assessed

A copy of the report is being issued to staff Lilyvelle Calzado for acknowledgment of receipt.
SUPERVISOR'S NAME: Michael CavaTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jennifer JonesTELEPHONE: (323) 518-3833
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1