197609713-5-5-2026-31-AS-TAGD-DUPSV5-20260603141209

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609713
Report Date: 05/05/2026
Date Signed: 05/05/2026 01:55:42 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
04/28/2026 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20260428111224

FACILITY NAME:	JMS RESIDENTIAL CARE		FACILITY NUMBER:	197609713
ADMINISTRATOR:	OLILA, MADONNA		FACILITY TYPE:	740
ADDRESS:	15346 MAYALL ST		TELEPHONE:	(818) 920-2995
CITY:	MISSION HILLS	STATE: CA	ZIP CODE:	91345
CAPACITY:	6	CENSUS: 3	DATE:	05/05/2026
		UNANNOUNCED	TIME BEGAN:	09:08 AM
MET WITH:	Nora Rosales - Staff		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff do not provide a safe environment for residents in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Tan conducted an unannounced initial complaint visit at this facility to investigate the above allegation. LPA met with Nora Rosales who called Administrator Madonna Olila and explained the reason for the visit. Ms. Olila designated Ms. Rosales to sign the report.

LPA conducted physical plant tour at 9:18 AM, requested copies of facility documents at 9:45 AM, reviewed documents between 10:00 AM to 11:00 AM and interviewed staff and residents between 11:00 AM to 1:00 PM. Regarding the allegation that Staff do not provide a safe environment for residents in care, it was alleged that Resident #1 (R1) hit Resident #2 unprovoked. LPA's record review revealed that both R1 & R2 are independent and able to care for themselves but R1 had a history of being aggressive towards staff not on any other residents. LPA's interview with Staff #1 (S1) who witnessed the entire incident revealed that on 04/24/26 at around 4:30 PM, S1 went to the dining area to pick up a call from the facility's landline and when S1 learned that the call was for R2, S1 summoned R2 who took the call on the landline. While talking on the phone, R1 passed by and hit R2 in the head without any provocation. (continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2026

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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Control Number 31-AS-20260428111224

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: JMS RESIDENTIAL CARE	FACILITY NUMBER: 197609713
	VISIT DATE: 05/05/2026

NARRATIVE

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(continued from LIC 9099)

LPA's interview with R2 confirmed the account of S1 that R2 came and hit R1 in the head with R1's fist. Another resident, Resident #3 (R3) also witnessed the incident and confirmed that there was no provocation from anyone when R1 hit R2 in the head when R1 passed by on the dining area where they were seated. Both R2 and R3 admitted that no one could have prevented it as there was no provocation whatsoever.

LPA's interview with another staff also revealed that it was R2's friend who called the police because it happened while they were talking on the phone. The police came about an hour later and picked up R1 and brought R1 to hospital and had not returned to the facility. LPA's interview with the Administrator today at 1:11 PM revealed that R1 is no longer coming back at the facility as they found out that R1 was keeping two (2) axes and fan knife on R1's bedroom and surrendered it to the police. Further, Administrator added that VA was informed that due to this dangerous episode and aggression they could no longer take R1 back, VA agreed that R1 should no longer be back at the facility.

Based on the information gathered during this visit, the allegation is deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2026

LIC9099 (FAS) - (06/04)

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