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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880610
Report Date: 08/04/2026
Date Signed: 08/04/2026 12:06:10 PM

Document Has Been Signed on 08/04/2026 12:06 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:BENSON HOUSE INC #16FACILITY NUMBER:
331880610
ADMINISTRATOR/
DIRECTOR:		DESIREE CABRERAFACILITY TYPE:
737
ADDRESS:222 CAMINO LOS BANOSTELEPHONE:
(951) 487-0350
CITY:SAN JACINTOSTATE: CAZIP CODE:
92583
CAPACITY: 4CENSUS: 3DATE:
08/04/2026
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Administrator, Humberto ArteagaTIME VISIT/
INSPECTION COMPLETED:
11:20 AM
NARRATIVE
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On August 4, 2026, Licensing Program Analyst (LPA), Jarred Torres, arrived at the facility unannounced to initiate a Case Management - Deficiencies inspection. LPA met with Administrator, Humberto Arteaga, explained the purpose of the visit, discussed deficiencies being cited, and developed plans of corrections.
  • LPA toured the facility with Humberto and inspected client files and the facility's Plan of Operation. During the tour, LPA observed jagged and uneven bricks in the back of the home, and the front door's doorknob being broken. Additionally, on June 23, 2026, the Department observed a trash can on the outside perimeter of the home with a broken lid and exposed trash. These issues present health, safety, and personal rights risks to clients in care as stated in California Code of Regulations (CCR), Title 22, Division 6, Chapter 1, section 80087(a), which states the facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. A deficiency was issued and a plan of correction was discussed and developed with Administrator, Humberto Arteaga.
  • Additionally, on June 23, 2026, the Department observed one of three client admission agreements to be expired, and the facility's Plan of Operation states they will comply with Title 17 and placement agency regulations to have an updated admission agreement for each client on an annual basis. One out of three client files contained an expired admission agreement, which was not in compliance with their Plan of Operation. CCR, Title 22, Division 6, Chapter 1, section 80022(k) states the facility shall operate in accordance with the terms specified in the Plan of Operation and may be cited for not doing so. A deficiency was issued and a plan of correction was discussed and developed with Administrator, Humberto Arteaga.

An exit interview was conducted, and this report along with appeal rights were discussed and provided to Administrator, Humberto Arteaga, whose signature on this form confirms receipt.
Jazmond D Harris
Jarred Torres
DATE: 08/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/04/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 08/04/2026 12:06 PM - It Cannot Be Edited


Created By: Jarred Torres On 08/04/2026 at 10:17 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: BENSON HOUSE INC #16
FACILITY NUMBER: 331880610

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/04/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/14/2026
Section Cited
CCR
80087(a)

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Buildings and Grounds, 80087(a): The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
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Licensee will contact their leasing company to complete repairs and send LPA proof of the repairs. Proof will be sent to CCLD via e-mail which should contain scans of work orders and photos of completed repairs by the POC due date.
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On June 23, 2026, the Department observed jagged and uneven bricks in the back of the home, a broken doorknob on the front door, lights hanging from the hood of the stove, and a broken trashcan with exposed trash, which poses potential health, safety, and personal rights risks to clients in care.
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Type B
08/31/2026
Section Cited
CCR80022(k)

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Admission Agreements, 80068(a): The facility shall operate in accordance with the terms specified in the Plan of Operation and may be cited for not doing so.

This requirement is not met as evidenced by:
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Licensee will review the cited section and train administrators on proper client file maintenance to ensure the Plan of Operations is executed as written. Licensee will also send LPA proof via e-mail of the training and corrected admission agreement.
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On June 23, 2026, the Department observed one of three client admission agreements to be expired, and the facility's Plan of Operation states they will comply with Title 17 and placement agency regulations to have an updated admission agreement for each client on an annual basis.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Jazmond D Harris
NAME OF LICENSING PROGRAM MANAGER:
Jarred Torres
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/04/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/04/2026


LIC809 (FAS) - (06/04)
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