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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336410683
Report Date: 10/12/2021
Date Signed: 10/12/2021 09:53:14 AM

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:BENCHMARK CARE ASSISTED LIVINGFACILITY NUMBER:
336410683
ADMINISTRATOR:ARLENE D. BAYSAFACILITY TYPE:
740
ADDRESS:26201 JANNEY DRTELEPHONE:
(951) 679-5327
CITY:SUN CITYSTATE: CAZIP CODE:
92586
CAPACITY:6CENSUS: 0DATE:
10/12/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:59 AM
MET WITH:Administrator Arlene BaysaTIME COMPLETED:
10:05 AM
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Licensing Program Analyst (LPA) Javina George conducted an unannounced visit for the purpose of following up on a voluntary closure of the facility. This visit is in response to telephone conversation that occurred on September 28, 2021, with Administrator informing her desire to close the facility as there have not been in residents in the home as of August 2021.

Administrator expressed that the mandates due to Covid-19 have taken away from the family aspect of the home and is now medically based, which is what caused her desire to no longer operate.

Upon arrival LPA observed a for sale sign in the front yard. LPA was greeted and granted entry by Administrator Arlene Baysa. LPA toured the facility and confirmed that there were not any residents in the home.

Administrator stated that the house was in escrow last week but the buyer backed out. Administrator stated that she may end up donating all the furniture such as hospital beds and wheelchairs and sell the home as a residential home and not a facility. LPA observed the and dressers to be empty, as well as the refrigerator and cabinets to be empty without food.

At the time of LPAs visit, Administrator voluntarily surrendered the original copy of the facility license to LPA on this October 12, 2021. LPA was also provided the signed certification of Non-operation that was signed by Licensee Regin Baysa.

An exit interview was conducted, and a copy of this report, and closure letter was reviewed with and provided to Administrator Arlene Baysa.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021
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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