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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601591
Report Date: 09/14/2021
Date Signed: 09/15/2021 04:02:05 PM



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
09/07/2021 and conducted by Evaluator Jennifer Jones
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20210907123921
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:
09/14/2021
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Lilyvelle Calzado, Lead Staff TIME COMPLETED:
04:10 PM
ALLEGATION(S):
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Staff do not treat residents with dignity.
Facility does not provide activities for residents.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jennifer Jones conducted an unannounced complaint visit. LPA met with Lilyvelle Calzado, Lead Staff and explained the reason for the visit.

During today's visit, LPA Jones toured the facility including residents bedrooms, bathrooms and observed 4 residents in care. LPA discussed the allegations and interviewed Lilyvelle Calzado, Lead Staff, staff 2 and residents 1 and 2. LPA requested copies of staff and resident roster activity schedule and all residents in care admission agreement.

The allegations revealed the following: For allegation:(Staff do not treat residents with dignity.) It is being alleged that staff are not treating residents with dignity and being held hostage in their rooms. It is also being alleged that staff are rude. LPA interviewed staff 1 and 2 about the allegations. Staff 1 and 2 denied the allegations and said residents are able to leave the room whenever they want. Staff 1 and 2 said some of the residents have TVs provided by their families in their rooms so they prefer to watch TV in their rooms instead of the living room. LPA interviewed residents 1 and 2 about the allegation.


Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Michael CavaTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jennifer JonesTELEPHONE: (323) 518-3833
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021
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 4
Control Number 11-AS-20210907123921
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: 09/14/2021
NARRATIVE
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R1 revealed during her interview that she is in her room all day looking at 4 walls.R1 said she has breakfast, lunch and dinner in her room. R1 stated that staff are not rude but she is depressed from being bored. R1 said when she is giving the opportunity to watch TV(only in the morning at 10am) in the living room. R1 said she cannot hear her shows because staff are loud when speaking with one another in a different language. LPA interviewed resident 2 who stated that she stays in her room most of the time but she can leave out of her room whenever she wants. R2 said staff are ok pretty nice. R2 has a TV in her room and says she watches TV in her room. LPA attempted to interview residents 3 and 4 but was unable to get a response.


For allegation:(Facility does not provide activities for residents) It is being alleged that the facility is not providing activities and only allows residents to watch TV time in the morning. Staff 1 said the residents are given physical therapy for exercise, the facility has games and residents are able to go outside on the patio for fresh air. Staff 1 provided LPA with an activity log dated January 2020 that indicates (10am Music hour and 2pm snack/TV). The calendar has the same activity every day for the entire month. LPA asked for an up to date activity schedule and the lead staff told LPA that the activities are the same everyday and it hasn't changed since the calendar month of January 2020. Staff 2 said she only assist with moving the residents from their beds to the wheelchairs if needed. Staff 2 said staff 1 works with resident 1 when it comes to activities and that she doesn't assist with activities. LPA Jones interviewed residents 1 and 2 and attempted to interview residents 3 and 4. Resident 1 stated that she stays in her room all day. R1 said she doesn't have a TV and is only able to watch TV in the mornings. R1 said it's a little difficult to hear the TV because of the interruptions from staff talking to each other. R1 stated that she does not receive physical therapy and only listens to music in her room. R1 stated that the facility does not offer games. R2 revealed during her interview that she stays in her room, watches TV and listens to music. R2 said she can go to the living room to watch TV but she has a TV in her room. R2 said she does not know about the activities offered in the facility.

Based on LPAs observations and interviews which were conducted and the records that were reviewed, the preponderance of evidence standard has been met, therefore the above allegations is found to be substantiated. California Code of Regulations, Title 22, Division (6) and Chapter (8) are being cited on the attached LIC 9099D.

A copy of the report was given to the Lead Staff, Lilyvelle Calzado
SUPERVISOR'S NAME: Michael CavaTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jennifer JonesTELEPHONE: (323) 518-3833
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 11-AS-20210907123921
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: 09/14/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/21/2021
Section Cited
CCR
87219(a)(1)-(6)
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Planned Activities Residents shall be encouraged to maintain and develop their fullest potential for independent living through participation in planned activities. The activities made available shall include (1) Socialization, achieved through activities such as group discussion and conversation, recreation, arts, crafts, music and care of pets.
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The administrator will update their activitty calendar and provide an up to date schedule of activities for residents in care. The administrator will submit to LPA by POC due date.
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... ...(6)Provision for free time so residents may engage in activities of their own choosing.
This requirement is met as evidence; based on interviews, the facility is not providing daily activities for residents and the facility failed to provide LPA with a current up to date calendar of activities for residents in care.
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Type B
09/21/2021
Section Cited
CCR
87468.2(a)(1)
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Additional Personal Rights of Residents in Privately Operated Facilities To have a reasonable level of personal privacy in accommodations, medical treatment, personal care and assistance, visits, communications, telephone conversations, use of the Internet, and meetings of resident and family groups. This requirement is not met as evidence by:
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The administrator will send CCL documentation indicating that they respect the privacy of residents and will allow residents privacy when watching TV. The administrator will send POC by due date
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Based on interviews conducted, The facility staff fail to allow resident privacy in the living room when watching TV by talking to each other when a resident is watching TV.
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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: Michael CavaTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jennifer JonesTELEPHONE: (323) 518-3833
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 11-AS-20210907123921
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: 09/14/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/21/2021
Section Cited
CCR
87506(a)
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The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement is not met as evidence by: The facility failed to provide LPA with admissions agreements
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The administrator will provide LPA with admission agreements for residents in care by POC due date.
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for all residents in care. LPA previously requested admission agreements for all 4 residents in care during previous visits on 08/30/21 and 09/07/21. LPA requested admission agreements on 09/15/21 and the facility still failed to provide LPA with admission agreements.
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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: Michael CavaTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jennifer JonesTELEPHONE: (323) 518-3833
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 4