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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361881063
Report Date: 05/23/2025
Date Signed: 05/23/2025 11:43:37 AM

Unsubstantiated


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
05/21/2025 and conducted by Evaluator Javier Prieto
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20250521152413
FACILITY NAME:BENNETT ADULT RESIDENTIALFACILITY NUMBER:
361881063
ADMINISTRATOR:CHAVEZ, JOANNAFACILITY TYPE:
735
ADDRESS:6351 SYRACUSE ST.TELEPHONE:
(909) 497-1990
CITY:CHINOSTATE: CAZIP CODE:
91710
CAPACITY:4CENSUS: 3DATE:
05/23/2025
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Rosa Olibares, Assistant AdministratorTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff did not ensure that client was adequately fed

Staff did not treat the client the same as other clients in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to conduct a complaint investigation regarding the above allegations. LPA Prieto met with Rosa Olibares, Assistant Administrator, and explained the elements of the complaint.

Allegation #1 - Resident #1(R1), in question, no longer resides at the home and unable to interview. LPA interviewed R2, R3 and R4, all who state they are adequately fed at the home. LPA observed facility food supply at the home to show a sufficient amount of perishables and non-perishables. LPA Prieto interviewed staff #1 (S1), S2 and S3, all stating resident's fed 3 times a day plus snacks. Staff have a monthly menu that is followed.

Allegation #2 - R1, in question, no longer resides at the home and unable to interview. LPA interviewed R2, R3 and R4, all who state they are treated equally and fairly at the home by staff. LPA Prieto interviewed staff #1 (S1), S2 and S3, all stating that residents are treated equally and express the residents attend group
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2025
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-20250521152413
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: BENNETT ADULT RESIDENTIAL
FACILITY NUMBER: 361881063
VISIT DATE: 05/23/2025
NARRATIVE
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functions together at the home, associated facilities and community functions. During this visit, LPA Prieto obtained pertinent documentation related to care of clients at the home.

Based on the information obtained there is not enough evidence to substantiate the allegations made in this complaint. Therefore, the allegations are deemed UNSUBSTANTIATED at this time. This report was signed by LPA Prieto and assistant administrator Olibares and copy was left with the facility.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2