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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336407366
Report Date: 09/10/2025
Date Signed: 09/10/2025 03:02:16 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO 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
07/01/2025 and conducted by Evaluator Raquel Hernandez
COMPLAINT CONTROL NUMBER: 56-AS-20250701090036
FACILITY NAME:BENSON HOUSE, INC. #6FACILITY NUMBER:
336407366
ADMINISTRATOR:ALFRED ORTIZFACILITY TYPE:
735
ADDRESS:4601 CALIFORNIA AVENUETELEPHONE:
(951) 279-8180
CITY:NORCOSTATE: CAZIP CODE:
92860
CAPACITY:5CENSUS: 5DATE:
09/10/2025
UNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:House Manager Nicole Martinez TIME COMPLETED:
03:10 PM
ALLEGATION(S):
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Staff did not prevent resident from engaging in self harm behaviors in the facility
Staff allowed resident to leave the facility unassisted

INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Raquel Hernandez conducted an unannounced visit to deliver findings on the allegation listed above. LPA met with House Manager Nicole Martinez and explained the purpose of the visit. The investigation consisted of client and staff interviews.

For the allegation, Staff did not prevent resident from engaging in self harm behaviors in the facility

LPA conducted (3) staff interviews. 3 out of the 3 stated clients are re-directed and facility staff will attempt to descalate any self-harming behaviors. Additionally, 3 out of the 3 staff stated a CPI hold is administered when needed. LPA spoke with Client #1 (C1) who stated facility staff do help when self-harm behaviors are present.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Raquel Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2025
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 2
Control Number 56-AS-20250701090036
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: BENSON HOUSE, INC. #6
FACILITY NUMBER: 336407366
VISIT DATE: 09/10/2025
NARRATIVE
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For the allegation, Staff allowed resident to leave the facility unassisted.

LPA conducted (3) staff interviews. Staff #1 (S1) stated no clients are allowed to leave facility unassisted. S1 indicated clients have the front yard and up to the mailbox before they are considered to be an elopement. 3 out of the 3 stated no clients have left the facility unassisted and if a client may depart from facility, facility staff will follow them and contact law enforcement when needed. LPA spoke with C1 who stated facility staff does not allow them to leave facility unassisted.

Based on the evidence gathered during today’s investigation, the allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

During today’s visit, no deficiencies pertaining to these allegations were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) was discussed and provided to House Manager Nicole Martinez.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Raquel Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2025
LIC9099 (FAS) - (06/04)
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