197607012-5-18-2020-31-AS-MVAO-BPZPPH-20200527112933

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607012
Report Date: 05/18/2020
Date Signed: 05/18/2020 05:12:03 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/24/2019 and conducted by Evaluator Melissa Spaeth

COMPLAINT CONTROL NUMBER: 31-AS-20190524155605

FACILITY NAME:	JBM RESIDENCE HOME, INC.		FACILITY NUMBER:	197607012
ADMINISTRATOR:	JOSEPHINE B. MIRANDA		FACILITY TYPE:	740
ADDRESS:	3205 ARIOUS WAY		TELEPHONE:	(661) 522-1968
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93536
CAPACITY:	6	CENSUS:	DATE:	05/18/2020
		UNANNOUNCED	TIME BEGAN:	04:00 PM
MET WITH:	Josephine Miranda		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Licensee increased resident's rent without proper notice

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) M. Spaeth conducted a complaint visit to investigate the above-mentioned allegation. LPA met with Josephine Mirranda to advise her of the purpose of the visit. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted as a FaceTime visit with Administrator. It was reported that Licensee increased resident’s rent without proper notice. LPA reviewed resident’s file and observed a certified letter was sent on June 11, 2018 to resident’s daughter advising of increase in the monthly service rate to $3,000.00 per month. The new Admissions Agreement was in resident's file and was signed by resident’s daughter and signed by the Administrator. Therefore, the finding is unsubstantiated at this time. A FaceTime exit interview was conducted with Administrator. A hard copy was provided via email to the Administrator requesting Administrator sign the document and return signed copy to LPA Spaeth

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Melissa Spaeth	TELEPHONE: (818) 421-2278
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2020

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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