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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336411349
Report Date: 05/16/2022
Date Signed: 05/16/2022 03:56:55 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/12/2022 and conducted by Evaluator Amy Goldenberg
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20220512110028
FACILITY NAME:BENSON HOUSE #7FACILITY NUMBER:
336411349
ADMINISTRATOR:ORALIA WILLIAMSFACILITY TYPE:
735
ADDRESS:910 RIVER DRIVETELEPHONE:
(951) 279-0366
CITY:NORCOSTATE: CAZIP CODE:
92860
CAPACITY:4CENSUS: 4DATE:
05/16/2022
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Oralia Williams, AdministratorTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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9
Staff do not allow resident to have private conversations
Staff speak inappropriately to a resident
INVESTIGATION FINDINGS:
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This unannounced visit conducted by Amy Goldenberg, Licensing Program Analyst (LPA), is being conducted to conclude this agency’s investigation into the complaint allegations mentioned above.

During the course of this investigation LPA interviewed six (6) staff members, interviewed three (3) clients, reviewed three (3) client records, and collected one copy of an individual program plan for C1. Investigation revealed the following:

It is alleged that C1 is made to use the phone in common areas, not allowing for private conversations. Five (5) of nine (9) interviews revealed that they have observed C1 being told that they have to use the phone in the common areas of the facility by staff. Interview further revealed S2 was observed refusing R1 privacy during a phone call by making them stay in the common area. This is a violation of R1s personal rights.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amy Goldenberg
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2022
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 56-AS-20220512110028
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: BENSON HOUSE #7
FACILITY NUMBER: 336411349
VISIT DATE: 05/16/2022
NARRATIVE
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It is alleged that staff speak inappropriately to residents. Four (5) of nine (9) interviews revealed that S1 was observed using inappropriate language toward R1, chasing them and using their arm to block R1 in a corner. This action is a violation of R1's personal rights.

We have substantiated the complaint allegations as valid and that a violation has occurred based on the preponderance of available evidence. A copy of this report along with appeal rights are being reviewed with, and furnished to the facility representative. Please see LIC 9099D.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amy Goldenberg
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 56-AS-20220512110028
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

FACILITY NAME: BENSON HOUSE #7
FACILITY NUMBER: 336411349
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/16/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/17/2022
Section Cited
CCR
85072(b)(9)
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The licensee shall insure that each client is accorded the following personal rights.To have access to telephones in order to make and receive confidential calls...
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Licensee to provide personal rights training to all employees of the facility by POC due date. Proof of training to be provided to CCL.
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R1's personal rights were violated as evidenced by when being made to use the phone in the common area of the facility. This is a personal rights violation.
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Type A
05/16/2022
Section Cited
CCR
80072(a)(1)
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Each client...To be accorded dignity in his/her personal relationships with staff and other persons.

The facility failed to meet this requirement as evidenced by
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Licensee to provide personal rights training to all employees of the facility by POC due date. Proof of training to be provided to CCL.
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 Four (5) of nine (9) interviews revealed that S1 was observed using inappropriate language toward C1 and using their arm to block C1 in a corner. This is a personal rights violation
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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.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amy Goldenberg
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3