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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361881063
Report Date: 10/15/2025
Date Signed: 10/15/2025 04:34:23 PM

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
10/14/2025 and conducted by Evaluator Javier Prieto
COMPLAINT CONTROL NUMBER: 56-AS-20251014125551
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:
10/15/2025
UNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Karen Doyle, House ManagerTIME COMPLETED:
04:40 PM
ALLEGATION(S):
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Resident was not accorded dignity in personal relationships with staff and other persons
Staff did not safeguard resident's personal belongings
Staff handled resident in a rough manner
Staff did not dispense medications as prescribed
Staff did not ensure that medications were properly stored
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 House Manager Doyle and explained the elements of the complaint.

Allegation #1 - House Manager Doyle (S1) explained that resident #1 (R1), in question, no longer resides at the facility and the allegation of R1 not afforded dignity in relationship between staff and other residents at the home, originates from R1 not afforded dignity to staff and other residents. S1 states that R1 has made threats to R2, R3 and R4. Staff #2 (S2) interviewed, reveals that threats were made by R1 to S2 of physical violence. Documentation obtained during this investigation reveal R1's behaviors of verrbal and physical threats towards others.

Allegation #2 - The safeguarding of R1's personal belongings, refers to health supplement product that was alleged was taken by staff. S1 reveals that this supplement was found by R1 on the last month of his
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2025
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-20251014125551
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: 10/15/2025
NARRATIVE
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residence at the home in April of 2025. Also obtained was an "Acknowledgment of Inventory Refusal and Personal Belongings Statement" document that confirms and acknowledges that R1 is taking all belongings.
Allegation #3 - S1 interview reveals that R1 handled R2 in a rough manner. It was documented that R1, threatened R2 and R1 was physically aggressive with R2.

Allegation #4 - S1 provided LPA with R1's Medication Administration Record (MAR) that reveals that R1 is receiving his medication as prescribed.

Allegation #5 - LPA toured the facility, where S1 showed LPA where the resident's medications were stored. Facility medication is locked and inaccessible to only staff.

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 signed by LPA Prieto and House Manager Doyle and a copy was left with the facility.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2