BENTLEY SUITES

Official classification

Type A

Official code

1569.605

Regulation authority

HSC

What the official deficiency says

HSC 1569.605 Liability insurance… all residential care facilities for the elderly … 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. This requirement was not met as evidenced by: Based on records reviewed, the Licensee did not maintain required liability insurance from 8/26/25 to 8/26/26 which includes a break down of the limits of liability which poses an immediate safety risk and personal rights risk to residents in care.

Official plan of correction

Licensee stated they will obtain liability insurance that complies with Health & Safety Code section 1569.605 and submit proof to LPA Felisa Shirley by POC due date of 4/16/26 by email, Attn: LPA Felisa Shirley at felisa.shirley@dss.ca.gov or fax to 424-544-1016.

Deadline recorded: Apr 16, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.605

Regulation authority

HSC

What the official deficiency says

Liability insurance… all residential care facilities for the elderly … 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. This requirement was not met as evidenced by: Based on records reviewed, the Licensee did not maintain required liability insurance from 8/26/25 to 8/26/26 which includes a break down of the limits of liability which poses an immediate safety risk and personal rights risk to residents in care.

Official plan of correction

Licensee stated they will obtain liability insurance that complies with Health & Safety Code section 1569.605 and submit proof to LPA Felisa Shirley by POC due date of 4/15/26 by email, Attn: LPA Felisa Shirley at felisa.shirley@dss.ca.gov or fax to 424-544-1016.

Deadline recorded: Apr 16, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303(a) Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidence by: Based on observation, interviews conducted, and record reviewed, Licensee did not ensure elevator was accessible to residents in care upon returning to the facility after the evacuation. This poses a potential health and safety risk to all residents in care. The facility has a proposal from Liftech Elevator Services, INC., and is in the process of reviewing the proposal and estimated costs.

Official plan of correction

(1) Administrator will submit a plan regarding repair for the elevator which includes when the elevator will be repaired and running properly. Administrator will submit updated working documents from the contractor with the plan and whether a new elevator will be installed. (2) Additionally, the facility will develop a plan to address how they will ensure the residents’ personal rights are not violated due to their inability to access the elevator. POC letters must be sent to LPA Perry Scott via email at perry.scott@dss.ca.gov by POC due date of 04/03/2026 to avoid monetary penalties.

Deadline recorded: Apr 3, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)(1)

Regulation authority

CCR

What the official deficiency says

Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: This requirement was not met as evidenced by: LPA observed camera in R1's room during the inspection which violates rights of the resident.

Official plan of correction

LPA observed cameras being disconnected during the visit. The POC was done at the time of visit.

Deadline recorded: Aug 12, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)(19)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities,..following personal rights: (19)To have prompt access to review all of their records and to purchase photocopies of their records. Photocopied records shall be provided within two (2) business days and at a cost that does not exceed the community standard for photocopies. This requirement was not met as evidence based on interviews and record reviews. The licensee did not ensure Resident R1's representitive received copies of documents requested.

Official plan of correction

Licensee will send copies of R1's documents in thier file to thier representative and will carbon copy (CC) LPA Wendy.Gibbs@dss.ca.gov on the email before the POC due date.

Deadline recorded: May 2, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87506(c)(1)

Regulation authority

CCR

What the official deficiency says

87506 - Resident Records (c) All information and records...shall be confidential.(1)The licensee shall be responsible for...inactive records... confidentiality of their contents. The licensee..shall make available to...designated representative. This has not been met as evidenced by: The licensee failed to produce any response to a resident's authorized representative (AR) between the dates of 03/05/25-04/02/25.

Official plan of correction

The licensee, S2, has agreed that the facility will forward all records of R1 to R1's authorized representative (AR). S2 has agreed that the facility will also carbon copy (CC) to mario.leon@dss.ca.gov on or prior to the POC due date which is 04/07/25.

Deadline recorded: Apr 7, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.153(d)

Regulation authority

HSC

What the official deficiency says

1569.153 Theft and loss program; standards, property inventories and surrender of personal effects; secured areas (d) A written resident personal property inventory is established upon admission and retained during the resident's stay in the residential care facility for the elderly. Inventories shall be written in ink, witnessed by the facility and the resident or resident's representative, and dated. A copy of the written inventory shall be provided to the resident or the person acting on the resident's behalf. All additions to an inventory shall be made in ink, and shall be witnessed by the facility and the resident or resident's representative, and dated. This requirement was not met as evidence by: Based on a review of records and interviews of (R#1-R#4), the facility staff failed to ensure residents personal belongings list was not created upon their admissions This poses a potential health and safety risk to all residents in care.

Official plan of correction

Licensee will ensure a list of personal belongings is create upon admission of resident. As plan of correction, licensee will re-do personal belongings of existing residents and new ones. A copy of the list will be sent to LPA via email before POC due date.

Deadline recorded: Dec 23, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87208(a)

Regulation authority

CCR

What the official deficiency says

87208 Plan of Operation (a) The licensee shall have and maintain a current, written definitive plan of operation for the facility. The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing so pursuant to Health and Safety Code section 1569.49. This requirement was not met as evidence by: Based on a review of records from new proof submitted to the department and the facility plan of operations, the facility staff failed to refill (R#1) medications. This poses a potential health and safety risk to all residents in care.

Official plan of correction

Licensee will adhere to Title 22 at all times. Licensee will submitt plan of correction to LPA Iniguez before POC due date.

Deadline recorded: Apr 22, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health.Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: Plan of Correction

Official classification

Type B

Official code

87412(a)(12)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (12) Hazardous health conditions documents as specified in Section 87411, Personnel Requirements - General. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: Plan of Correction

Official classification

Type B

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This has not been met as evidenced by: Licensee has yet to repair the lift which would allow non-ambulatory resident(s) to freely travel from the second story of the facility to the ground floor.

Official plan of correction

Assistant Administrator and LPA have agreed that the facility will send video evidence of a working lift, on or prior to the POC due date, via email, to LPA at Mario.Leon@DSS.CA.GOV

Deadline recorded: Jul 9, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(k)(8)

Regulation authority

CCR

What the official deficiency says

87705 care of persons with dementia (k) The fol requirements must be met... doors and perimeter fence gates. (8) delayed agress devices shall not substitute for trained staff... This requirement was not met as evidenced by: Based on LPA observations, interviews conducted and records reviewed the licensee failed to ensure that the delayed egress did not substitute for trained staff, which poses an immediate health and safety risk to clients in care.

Official plan of correction

Administrator agrees to secure all exits with key code locks to prevent residents from leaving the facility without staff help.

Deadline recorded: Jan 29, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87466

Regulation authority

CCR

What the official deficiency says

87466 Observation of the Resident: The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as unusual weight gains or losses..This requirement was not met as evidenced by: Based on LPA observations, interviews conducted and records reviewed the licensee failed to ensure that the resident weight loss was not monitored which poses an immediate health and safety risk to clients in care.

Official plan of correction

Administrator will keep accurate weight loss records for clients in care.

Deadline recorded: Jan 29, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(f)(1-2)

Regulation authority

CCR

What the official deficiency says

87303(f)(1-2) Maintenance and Operation (f)Solid waste shall be stored and disposed of as follows: (1)Solid waste shall be stored, located and disposed of ...transmission of a communicable disease or of odors, create a nuisance, provide a breeding place or food source for insects or rodents. (2)Syringes and.. with the California Code of Regulations, Title 8, Section 5193 concerning bloodborne pathogens. Based on observation, and interview, the licensee did not comply with the section cited above in, screens in despair, accessibility, and drywall, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee will fix windows, screens in despair, accessibility, and drywall of the facility by POC due date. Licensee will email proof of correction to David.espana@dss.ca.gov.

Deadline recorded: Jan 14, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a-e)

Regulation authority

CCR

What the official deficiency says

87303 (a-e) Maintenance and Operation (a)The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision... the safety and well-being of residents, employees and visitors. (1) Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition…(c) All window screens shall be clean and maintained in good repair. (d)There shall be...the use of each room and sufficient to ensure the comfort and safety of all persons in the facility. (e)Water supplies and.... maintained as follows: (1)All community care facilities where water for human consumption is from a private… Based on observation, and interview, the licensee did not comply with the section cited above in, flammable grasses, no access door to side of facility, pigeons and pigeon cages, and flies and insects, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee will address flammable grasses, no access door to side of facility, pigeons and pigeon cages, and flies and insects at the facility by POC due date. Licensee will email proof of correction to David.espana@dss.ca.gov.

Deadline recorded: Jan 14, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. LPA identified room #1 & 2 had hot water temperature range at 161.2 -165.9 degree F. This violation which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/05/2023 Plan of Correction Hot water temperature must meet the Title 22 regulations requirement of not less than 105. degree F and not more than 120 degree F. Licensee will make correction to reduce the water temperature to meet the requirements at all times. Proof of correction must be sent to LPA Dabuet at: ernand.dabuet@dss.ca.gov no later than 11/05/23. *Corrected during visit 11/04/23* Corrected during visit on 11/04/23.

Official classification

Type A

Official code

87204(b)

Regulation authority

CCR

What the official deficiency says

(b) Resident rooms approved for 24-hour care of ambulatory residents only shall not accommodate nonambulatory residents. Residents whose condition becomes nonambulatory shall not remain in rooms restricted to ambulatory residents. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, record review, the licensee did not comply with the section. Resident #4 who is bedridden is in a ambulatory room 7A not cleared for bedridden room. The licensee is operating beyond the conditions and limitations specified on the license. This violation which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/05/2023 Plan of Correction The licensee will need to transfer hospice resident #4 to an approved bedriddent room 1,3, 4 or 5 in order to correct this violation. This violation must be completed by due date 11/05/23. Proof of correction must be sent to ernand.dabuet@dss.ca.gov *Immediate Civil Penalty*

Official classification

Type A

Official code

87307(d)(6)

Regulation authority

CCR

What the official deficiency says

(6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. LPA identified funiture, mattress, wheelcair and other furnishing supplies obstructing passage way adjacent to room #10. Staff indicated this furnishings have been blocking passage way for several days. This violation which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/05/2023 Plan of Correction Licensee will remove furnishing obstructing passage way immediately. Proof of correction must be sent to LPA at ernand.dabuet@dss.ca.gov by due date 11/05/23. *Corrected during visit on 11/04/23*

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation., the licensee did not comply with the section cited above. LPA identified open powder bleach under bathroom sink accessible to dementia residents in care in room #7. This violation which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/05/2023 Plan of Correction LIcensee will adhere to Title 22 regulations section 87309 and ensure that all toxic, hazardous chemical items are store in locked cabinets and not accessible to residents in care. Proof of correction must be sent to LPA at ernand.dabuet@dss.ca.gov by 11/05/23. *Corrected during visit on 11/4/23*

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. LPA identified room #19 bathroom baseboards had rust/mold and need to be replaced. This violation which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/04/2023 Plan of Correction Licensee will make necessary repairs and replace with new bathroom baseboards. Proof of correction must be sent to LPA at ernand.dabuet@dss.ca.gov by 12/04/23.

Official classification

Type B

Official code

1569.695(c)

Regulation authority

HSC

What the official deficiency says

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above. LPA identified the facility had not conducted a recent quarterly fire drill. The last drill was completed in June 2023. This violation which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/18/2023 Plan of Correction Licensee will adhere to H & S regulations 1569.695 and continue to conduct quarterly fire drills. Proof of correction must be sent to LPA at ernand.dabuet@dss.ca.gov by due date 11/18/23.

Official classification

Type A

Official code

1569.065

Regulation authority

HSC

What the official deficiency says

Type A: HSC 1569.605 – Liability insurance… all residential care facilities for the elderly … 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. This requirement was not met as evidenced by: Based on liability insurance records reviewed, interviews conducted with Administrator and relevant witnesses, it was determined that the licensee did not have required liability insurance coverage for 08/26/2022 to present which poses an immediate safety risk to residents in care.

Official plan of correction

Licensee stated they will obtain liability insurance that complies with Health & Safety Code section 1569.605 and submit proof to LPA by POC due date (05/24/23).

Deadline recorded: Aug 23, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(A)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation.(A)The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Based on interviews, observations and records the licensee failed to provide CDSS with a addendum to the facility plan of operation and failed to control the movement of 30 pigeons or clean the pigeon fecies. This poses a potential health & safety risk to residents in care.

Official plan of correction

Plan of correction, Administrator will move alll pigeons off the facility property by 06/16/2023 and will provide LPA Calderon with written proof of same.

Deadline recorded: Jun 16, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87224(c)(d)(1)

Regulation authority

CCR

What the official deficiency says

87224 Eviction Procedures The licensee shall, in addition to either serving the required thirty (30) days notice , sixty (60) days notice or seeking approval from the Department and service three (3) days notice on the resident, notify or mail a copy of the notice to quit to the resident's responsible person. Resident 1 was issued an eviction notice on 11/29/2022, however, the facility failed to submit a copy of the 30-Day Eviction notice with reasoning for eviction to the Community Care Licensing office as required by Title 22 Regulations. The violation poses a potential health and safety risk to residents in care.

Official plan of correction

The licensee will review Title 22 Regulations, Section 80068.5, Eviction Procedures, and submit a written plan on how 30-day or 3-day evictions will be handled according to the Title 22 Regulation requirement in the future. The licensee will submit a plan of correction to CCL office by the POC due date of 12/20/2022.

Deadline recorded: Dec 20, 2022. A deadline is not proof that correction was completed.