198602963-3-19-2024-11-AS-RORN-D3KLM5-20240321085211

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602963
Report Date: 03/19/2024
Date Signed: 03/19/2024 11:01:57 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/13/2024 and conducted by Evaluator Elvira Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20240213161133

FACILITY NAME:	BEN T'S FAMILY CARE		FACILITY NUMBER:	198602963
ADMINISTRATOR:	KIMBERLY LEE		FACILITY TYPE:	735
ADDRESS:	17700 EXA CT		TELEPHONE:	(323) 779-1842
CITY:	CARSON	STATE: CA	ZIP CODE:	90746
CAPACITY:	4	CENSUS: 3	DATE:	03/19/2024
		UNANNOUNCED	TIME BEGAN:	10:12 AM
MET WITH:	Lupe Ross		TIME COMPLETED:	11:20 AM

ALLEGATION(S):

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Staff did not ensure that bathroom is kept cleaned in between use.
Staff did not ensure that clean towels are being used to clean the facility.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced subsequent complaint visit to this facility to deliver the complaint findings. LPA met with House Manager Lupe Ross and explained the purpose of today's visit.

The investigation consisted of: During the initial visit conducted on 02/23/2024, LPA Elvira Gonzalez, and Licensing Program Manager (LPM) Stephanie Cifuentes reviewed three client files and requested copies of staff and client rosters. LPA, LPM, and House Manager Lupe Ross toured the facility including observations of bathroom #1 and #2. LPA Gonzalez additionally interviewed Client 1 (C1) and Staff 1 (S1). On 02/28/24 at 4:05 PM, LPA interviewed C2 via telephone, and attempted to interview C3. On 02/28/24 LPA interviewed S3 via telephone and attempted to interview S2. On 03/12/24 at 10:34 AM, LPA interviewed S2 via telephone.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2024

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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Control Number 11-AS-20240213161133

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: BEN T'S FAMILY CARE	FACILITY NUMBER: 198602963
	VISIT DATE: 03/19/2024

NARRATIVE

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Investigation revealed the following: Regarding the allegation: Staff did not ensure that bathroom is kept cleaned in between use, it is alleged that facility staff do not clean toilets in between use. It is also alleged that administrator is aware and does not ensure that bathrooms are clean. Interviews conducted with 1 out of 2 clients revealed that staff do not ensure that the bathrooms are kept clean in between use. 1 out of 2 clients stated that bathrooms are always clean. 1 out of 3 clients did not want to be interviewed. Interviews conducted with 3 out of 3 staff revealed that bathrooms are cleaned daily and as needed. On 02/23/24, LPA observed bathrooms 1 and 2 to be clean and sanitary. Based on statements gathered from interviews conducted with clients, staff, and LPA observations, there was not enough supportive evidence to concur with the reported allegation.

For allegation: Staff did not ensure that clean towels are being used to clean the facility, it is alleged that there dirty towels are left on the kitchen counter. It is also alleged that everyone cleans with dirty towels and that the towels are being used to clean the floors and the counters. Interviews conducted with 2 out of 2 clients revealed that staff do ensure that clean towels are being used to clean the facility. 2 out 2 clients stated that they haven’t noticed staff using dirty towels to clean the facility or using that same towel to clean the kitchen floor. Interviews conducted with 3 out of 3 staff revealed that staff always clean the kitchen counters with a clean towel. 3 out of 3 staff stated that they clean the floors with a mop. On 02/23/24, LPA did not observe dirty towels left on the kitchen counter, or dirty towels being used to clean the floors and the counters. Based on interviews and LPA observations, there was not enough supportive evidence to concur with the reported allegation.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview held. A copy of the report was provided to House Manager Lupe Ross.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2024

LIC9099 (FAS) - (06/04)

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