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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 360908345
Report Date: 11/04/2022
Date Signed: 11/04/2022 10:16:44 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
12/22/2020 and conducted by Evaluator Natalie Ibarra
COMPLAINT CONTROL NUMBER: 18-AS-20201222114547
FACILITY NAME:BENSON HOUSEFACILITY NUMBER:
360908345
ADMINISTRATOR:SHAWN COLETTAFACILITY TYPE:
735
ADDRESS:1941 S. BENSONTELEPHONE:
(909) 983-7884
CITY:ONTARIOSTATE: CAZIP CODE:
91762
CAPACITY:9CENSUS: DATE:
11/04/2022
UNANNOUNCEDTIME BEGAN:
10:07 AM
MET WITH:Shawn ColettaTIME COMPLETED:
10:25 AM
ALLEGATION(S):
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Staff unlawfully evicted a client while in care
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Natalie Ibarra and Victoria Chitgian conducted an unannounced visit to the facility to deliver findings for the above allegation. LPAs met with administrator Shawn Coletta and explained the purpose of today’s visit. The investigation consisted of interviews with pertinent parties.

The allegation indicates staff unlawfully evicted a client while in care. Interview with Staff #1 (S1) stated a 30-day eviction notice was given to Client #1 (C1) after an incident in where C1 assaulted and threatened to kill staff. C1 also has destroyed facility property and was a danger to them self and others at the facility. S1 states the facility was not able to meet C1’s needs. On 12/7/20 a 30-day eviction was served to C1 but was allowed to remain at the facility till Regional Center was able to find C1 a new placement. C1 moved out of the facility on 3/1/21. Interviews with Staff #2 (S2) and Staff #3 (S3) stated C1 was aggressive to staff and would destroy facility property.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Natalie Ibarra
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2022
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 2
Control Number 18-AS-20201222114547
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: BENSON HOUSE
FACILITY NUMBER: 360908345
VISIT DATE: 11/04/2022
NARRATIVE
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Based on the information obtained, the allegations are UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted, and a copy of this report was discussed and provided to Administrator.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Natalie Ibarra
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2