Facility Evaluation Report
On 09/17/25, Licensing Program Analyst (LPA) Lizeth Villegas conducted a case management visit in response to the Special Incident Report submitted to CCLD on 09/15/25 for an incident occurring on 09/13/25; regarding staff #1 and client #1 (C1). LPA met with Licensee Sandra Benson as the purpose of the visit was explained.
During today’s visit LPA Villegas conducted a Health & Safety visit which consisted a tour of the physical plant, and obtaining of the following: client and staff rosters, and a copy of Client #1(C1) records: Face sheet, Physicians report, Individual Program Plan 2024, Psychiatry visit form, daily notes for September 2025, medication list. Copies of photos related to the incident report, and security camera footage to be sent to LPA via email. LPA also obtained copies of staff #1’s records: Fingerprint clearance, LIC 501, LIC 503, LIC 508, SOC 341A, in-service sign in sheets for 2025, employee rights, exemption approval, criminal record exemption transfer request, DSP 1 and 2 certification. On 09/17/25 LPA reviewed security camera footage and photos taken of C1 after incident on 09/13/25.
On 09/15/25 LPA received an unusual incident report, reporting that on 09/13/25 staff #1 (S1) assaulted client #1 (C1). On 09/17/25 LPA conducted conducted an interview with Licensee regarding the incident that occurred on 09/13/25. On 09/17/25 Licensee confirmed the incident that occurred on 09/13/25, and stated that S1 assaulted C1 which caused bruising. On 09/17/25 LPA conducted a review of security camera footage, LPA observed S1 repeatedly punching C1 in the face, kicking C1 to the body, pulling C1 hair, and pushing C1 onto the couch.
Based on LPAs observations and interviews which were conducted record review(s), the preponderance of
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction