Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609123
Report Date: 07/20/2017
Date Signed: 07/20/2017 11:52:55 AM


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/07/2016 and conducted by Evaluator Patrick Shanahan
COMPLAINT CONTROL NUMBER: 31-SC-20161207145340
FACILITY NAME:BENTLEY SUITES BY SERENITY CARE HEALTHFACILITY NUMBER:
197609123
ADMINISTRATOR:MONA ALCARAZFACILITY TYPE:
740
ADDRESS:851 4TH STREETTELEPHONE:
(213) 478-0800
CITY:SANTA MONICASTATE: CAZIP CODE:
90403
CAPACITY:44CENSUS: 29DATE:
07/20/2017
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Renel CabralTIME COMPLETED:
12:22 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff threatens residents to leave and residents are afraid of retaliation

Administrator on record does not operate/administer the facility
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Patrick Shanahan arrived at the facility and was greeted by the lead caregiver, Renel Cabral. LPA explained the reason for the visit. Lead Caregiver provided the LPA with a staff and resident roster.
In regards to allegation one, LPA was able to interview staff and residents. A tour of the physical plant was also conducted . Based on interviews and documentation gathered , this allegation is deemed to be unsubstatiated at this time.
In regards to the secound allegation, LPA was also able to tour the facility and conduct interviews with staff and residents. Based on interviews, It appears that the administrator may not always be at the facility but is always accessable over the phone. Administrator does spent about 5 hours a day at the facility and there was noone at the facility that claimed to be an assistant administrator or appeared to take on the responsiblities of the administrator. Based on information gathered from interviews and documentation, this allegation is deemed to be un substatiated.
As of January 1, 2017, the term “inconclusive” is no longer used to refer to the outcome of certain complaint investigations. Such complaint allegations are now deemed “unsubstantiated.” This document has not yet been updated to reflect this change and for purposes of this complaint investigation the Department’s finding is that this allegation was unsubstantiated.

Exit interview conducted and a copy of this report was issued.
Inconclusive
Estimated Days of Completion:
SUPERVISOR'S NAME: Maryjo SchnitzerTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Patrick ShanahanTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2017
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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