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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601591
Report Date: 12/07/2021
Date Signed: 12/10/2021 09:42:00 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:
12/07/2021
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
05:45 PM
MET WITH:Mona Alcaraz and Lilybelle CalzadoTIME COMPLETED:
05:46 PM
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Licensing Program Analyst (LPA) Ulysses Coronel and LPA Ngozi Nwaokoro conducted an unannounced Case Management - Legal/Non-compliance visit to obtain a copy of the facility's Certificate of liability insurance. LPAs spoke to the administrator Mona Alcaraz met with Lead Staff, Lilybelle Calzado and the purpose of today's visit was explained.

During todays visit LPA Coronel obtained a copy of the facility's certificate of liability insurance.

No deficiency regarding liability insurance was cited today.

An exit interview was conducted and hard 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
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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