331880682-7-17-2024-18-AS-TDAN-D7MUSF-20240729155016

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880682
Report Date: 07/17/2024
Date Signed: 07/17/2024 01:32:49 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/09/2024 and conducted by Evaluator Sara Martinez

COMPLAINT CONTROL NUMBER: 18-AS-20240709165013

FACILITY NAME:	BENSON HOUSE INC #19		FACILITY NUMBER:	331880682
ADMINISTRATOR:	DESIREE CABRERA		FACILITY TYPE:	737
ADDRESS:	41218 CREST DR		TELEPHONE:	(951) 392-3682
CITY:	HEMET	STATE: CA	ZIP CODE:	92544
CAPACITY:	4	CENSUS: 3	DATE:	07/17/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Alicia Beccue - Administrator Assistant		TIME COMPLETED:	01:40 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are operating out of ratio

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Sara Martinez conducted an unannounced visit to initiate a complaint investigation into the allegation listed above. LPA met with Administrator Assistant Alicia Beccue and discussed the purpose of the visit. LPA’s visit consisted of a tour of the facility, interviews, and collected pertinent documents for the complaint investigation.

It was alleged that the facility has a census of 3 clients with a 2:1 ratio that is not being met by facility staff. Upon arrival, LPA observed that there was eight (8) staff member and three (3) clients inside the facility receiving care and supervision. LPA conducted records review of the three (3) clients Individualized Program Plan (IPP) from Inland Regional Center (IRC) that revealed Client One (C1) has a staff ratio of 2:1 for AM, PM, NOC shift, Client Two (C2) has a staff ratio of 2:1 for AM, PM, NOC shift, and Client Three (C3) has a staff ratio of 1:1 for AM, PM, NOC shift.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tricia Danielson	TELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Sara Martinez	TELEPHONE: (951) 605-0913
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 18-AS-20240709165013

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 #19	FACILITY NUMBER: 331880682
	VISIT DATE: 07/17/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Records review of facility staff schedule for June 2024 PM shift and July 2024 PM shift revealed on 06/08/2024, 06/16/2024, 06/26/2024, 07/07/2024, 07/08/2024, 07/11/2024, 07/14/2024 and 07/15/2024 they had only three (3) to four (4) staff working due to staff calling off and or no shows. Interview with Administrator Assistance Alicia Beccue revealed they try to have eight (8) employees scheduled for each shift. When staff call off from work, the facility staff will try to find a replacement to come into work or request staff from other houses associated with this facility to assist with staff not showing up to work. Based on LPA’s interviews and records review, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations Title 22, Division 6, Chapter 6, are being cited on the attached LIC 9099 D. An exit interview was conducted, and a copy of this report along with Appeal Rights was provided to Beccue.

SUPERVISOR'S NAME: Tricia Danielson	TELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Sara Martinez	TELEPHONE: (951) 605-0913
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 18-AS-20240709165013

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 #19	FACILITY NUMBER: 331880682
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/17/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/26/2024 Section Cited CCR 85065.5(a)	1 2 3 4 5 6 7	Day Staff-Client Ratio: (a) Whenever a client who relies upon others to perform all activities of daily living is present, the following minimum staffing requirements shall be met...This requirement was not being met as evidenced by:	1 2 3 4 5 6 7	Licensee agrees to develop a plan to ensure that this facility does not go over client to staff ratio. Additionally, Licensee agrees that in-service training will be conducted and provided to CCL by the POC date 07/26/2024.
	8 9 10 11 12 13 14	Based on LPA's interviews and records review, the Licensee did not ensure the staff ratio for care and supervision set by Inland Regional Center (IRC) was not being met for client one (C1), client two (C2), and client three (C3) which poses a potential health, safety, and personal rights risk to clients in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Tricia Danielson	TELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Sara Martinez	TELEPHONE: (951) 605-0913
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 3