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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 360908345
Report Date: 09/15/2025
Date Signed: 09/15/2025 01:57:57 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
09/09/2025 and conducted by Evaluator Raquel Hernandez
COMPLAINT CONTROL NUMBER: 56-AS-20250909135436
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: 5DATE:
09/15/2025
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Administrator Shawn ColettaTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Staff chemically restrain clients
Staff leave client soiled for an extended period of time
Staff are not meeting clients toileting needs
Staff are not keeping the facility odorless
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Raquel Hernandez conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Administrator Shawn Coletta and explained the purpose of the visit. The investigation consisted of staff, facility tour and client interviews.

For the allegation, Staff chemically restrain clients

LPA conducted (1) client interview. Client #1 (C1) stated facility staff do not chemically restrain clients in care and receives their daily medications as prescribed. LPA observed (2) clients medications and Medication Administration Record (MAR) no issues were observed. LPA spoke with Administrator who stated clients are given daily medications and only administer PRN medications upon client's request.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Raquel Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2025
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-20250909135436
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
FACILITY NUMBER: 360908345
VISIT DATE: 09/15/2025
NARRATIVE
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For the allegation, staff leave client soiled for an extended period of time

LPA spoke with C1 who stated facility staff do not leave them soiled for an extended period of time. Additionally, LPA conducted (2) staff interviews. 2 out of the 2 staff stated clients are not left soiled for an extended period of time and are assisted in a timely manner. Additionally, LPA observed sign off sheet for checking clients in care throughout the night on NOC shift.

For the allegation, Staff are not meeting clients toileting needs

LPA spoke with C1 who stated facility staff do assist with toileting needs and will provide assistance in a timely manner. Additionally, LPA observed C1's care notes indicating when toileting assistance is needed. LPA conducted (2) staff interviews. 2 out of the 2 staff stated clients toileting needs are met and all clients in care are assisted with toileting needs.

For the allegation, Staff are not keeping the facility odorless

LPA observed facility to be odorless during visit. LPA spoke with C1 who stated facility is kept odorless. LPA conducted (2) staff interviews. 2 out of the 2 staff stated facility is kept odorless.

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 Administrator Shawn Coletta.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Raquel Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2