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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880610
Report Date: 08/24/2021
Date Signed: 08/24/2021 12:43:19 PM

Document Has Been Signed on 08/24/2021 12:43 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:BENSON HOUSE INC #16FACILITY NUMBER:
331880610
ADMINISTRATOR:CABRERA, DESIREEFACILITY TYPE:
737
ADDRESS:222 CAMINO LOS BANOSTELEPHONE:
(951) 487-0350
CITY:SAN JACINTOSTATE: CAZIP CODE:
92583
CAPACITY: 4CENSUS: 2DATE:
08/24/2021
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Jack Hinchman, President
Aurelia Williams, Senior Administrator
TIME COMPLETED:
12:06 PM
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Regional Manager (RM) Reyna Lacey, Regional Manager Leslie Mendiveles, Licensing Program Analyst (LPA) Tricia Danielson, and San Bernardino County Public Health Nurse (PHN) Kelli Clark, met with Benson House President (PR) Jack Hinchman and Senior Administrator (SA) Aurelia Williams virtually via Microsoft Teams to obtain a status update on the infection control practices of all Benson House facilities. The following is a summary of the visit.
RM Lacey provided a review of the COVID history of Benson House facilities. Eleven (11) of fifteen (15) Benson House facilities have reported positive COVID cases. Twelve (12) of the sixty (60) positive COVID cases have been clients. All Benson House facilities have had Technical Assistant (TA) visits except Benson House #19, which is a new facility and a Technical Assistant (TA) visit is being scheduled. RM Lacey thanked PR Hinchman for the timely efforts Benson House has made to report COVID cases to the department.

RM Lacey inquired about the company's status of Benson House facilities sharing staff. PR Hinchman reported no staff are shared between the Benson House facilities. RM Lacey inquired as to what plan they have to address staffing shortages. PR Hinchman reported they use overtime and/or on call staff. PR Hinchman stated he is even on call himself in the event a facility needs emergency staffing. PR Hinchman reported there have been no staffing issues in any Benson House facility to date.

RM Lacey inquired about what percentage of Benson House staff is vaccinated. PR Hinchman reported he was not aware. SA Williams reported Benson House is currently compiling a log to track vaccinated staff. Benson House is also utilizing testing kits which can provide a rapid result within 15 minutes. RM Lacey asked if Benson House requires assistance with obtaining vaccinations. SA Williams reported all clients are vaccinated now. PR Hinchman reported he believes with the recent approval of the Pfizer vaccine will provide more reassurance so more staff will get vaccinated. SA Williams reported they have a nurse who
comes in and provides training on use of PPE and can answer questions for staff regarding vaccination. (CONTINUED ON LIC 809C)
SUPERVISORS NAME: Reyna Lacey
LICENSING EVALUATOR NAME: Tricia Danielson
LICENSING EVALUATOR SIGNATURE: DATE: 08/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/24/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: BENSON HOUSE INC #16
FACILITY NUMBER: 331880610
VISIT DATE: 08/24/2021
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(CONTINUED FROM LIC809)
Benson House has also contacted the county to obtain an inservice for staff but the were informed the county is backlogged and therefore cannot do the inservices for Benson Houses at this time. PHN Clark and RM Lacey requested the name of the county rep spoken to so CCL can assist Benson House in getting an inservice in a timely manner.

RM Lacey inquired about what screening protocols are set up in Benson Houses. SA Williams reported temperatures are taken, staff and visitors are screened for symptoms and are not allowed in a facility with any symptoms even if it's believed to be allergies. The testing kits have allowed Benson Houses to test staff immediately or send them to be tested.

RM Lacey asked how the licensee ensures protocols/training provided are followed at each facility. SA Williams reported AD's ensure the wellness stations are stocked and that each staff is utilizing PPE supplies and following protocols. SA Williams reported she has gone out to facilities herself and made observations to ensure protocols are followed. PR Hinchman also reported visiting facilities to make observations as well.

RM Lacey asked who the Infection Control lead is in each facility. PR Hinchman and SA Williams both reported the Administrator (AD) in each home is the Infection Control lead person. RM Lacey asked


what their role is and what guidance do they provide Benson House staff and clients. SA Williams reported ADs go through the home and ensure staff are following protocols and using PPE properly. They also ensure staff and clients are safe. SA Williams reported Benson House has discovered that staff are becoming infected outside of the facility and on their own time. SA Williams reported Benson House's HR department conducts an interview of each infected person and gathers information from them to assist them in putting protocols in place.

PHN Clark provided consultation regarding the proper use of infection control disinfection solutions, donning and doffing PPE, monitoring air conditioning filters, the importance of maintaining a healthy lifestyle to assist in fighting COVID.

RM Lacey reviewed and provided PIN 21-32.1.
The virtual meeting ended and LPA Danielson conducted an exit interview with SA Williams. A copy of this report was provided via email and SA Williams will return a signed copy to LPA Danielson.
SUPERVISORS NAME: Reyna Lacey
LICENSING EVALUATOR NAME: Tricia Danielson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021
LIC809 (FAS) - (06/04)
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