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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601877
Report Date: 02/10/2022
Date Signed: 02/10/2022 01:03:51 PM

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 MANOR BY SERENITY CARE HEALTHFACILITY NUMBER:
198601877
ADMINISTRATOR:MONA ALCAREZFACILITY TYPE:
740
ADDRESS:3425 MCLAUGHLIN AVE.TELEPHONE:
(213) 478-0800
CITY:LOS ANGELESSTATE: CAZIP CODE:
90066
CAPACITY:27CENSUS: 15DATE:
02/10/2022
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Mona AlcarezTIME COMPLETED:
01:10 PM
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On 2/10/22 at 12:35 p.m., Licensing Program Analyst/ (LPA) Susan Campos conducted an unannounced Case Management visit to the Bentley Manor. LPA was allowed entry into the facility by Mona Alcarez, Administrator. LPA explained to Ms. Alcarez the purpose of today's visit is to follow up on Proof of Liability Insurance citation issued on September 24, 2021.

The LPA/ Regional office was provided a copy of the facility liability insurance that included the same policy number, for two different facilities, Bentley Manor (#198601877) by Serenity Care Health, and the Bentley House (#198601591) located at 3449 Rosewood Ave, Los Angeles, CA 90066. LPA explained to the Ms. Alcarez, that multiple facilities cannot share the same policy or be combined. As of today's visit, no changes have been made to the liability insurance coverage provided to the LPA/ Regional office.

The facility has failed to comply with the POC that was issued on 09/24/2021. Additional citations are being issued under regulation 1569.605 LIABILITY INSURANCE; COVERAGE REQUIREMENTS. On and after July 1, 2015, all residential care facilities for the elderly, except those facilities that are an integral part of a continuing care retirement community, shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate, caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees.

Civil Penalties assessed and an exit interview was conducted with Mona Alcarez. A copy of the LIC 809 report and appeal rights was provided to Ms. Alcarez.
SUPERVISOR'S NAME: Michael CavaTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Susan CamposTELEPHONE: (323) 629-7445
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2022
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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