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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361800195
Report Date: 01/23/2023
Date Signed: 01/23/2023 10:53:14 AM

Document Has Been Signed on 01/23/2023 10:53 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME:JDJ BEHAVIORAL INCORPORATEDFACILITY NUMBER:
361800195
ADMINISTRATOR:ELIZABETH GONZALEZFACILITY TYPE:
735
ADDRESS:2385 PEACOCK AVENUETELEPHONE:
(909) 907-5867
CITY:HIGHLANDSTATE: CAZIP CODE:
92346
CAPACITY: 4CENSUS: 4DATE:
01/23/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:03 AM
MET WITH:Angie HuradoTIME COMPLETED:
10:56 AM
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Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced case management visit to this facility regarding an incident report received by the Department on 12/22/22. LPA met with direct support staff (DSP) Angie Hurado and administrator Elizabeth Gonzales was phoned. The following is a summary of the incident:

On 12/19/22, Officer Redman from the local police department visited the facility regarding an allegation made by Client 1 (C1) at their day program that a staff at this home hit C1 in the face causing redness. The responding officer spoke with all staff, C1, and all other clients and no report was written. On 12/21/22, the facility sent C1 to the hospital where they were diagnosed with an infection related to C1's redness.

During today's visit, Gonzales shared that C1 admitted that no staff hit them but that they were upset because they could not have a baked dessert item. Gonzales added that there was no known infections in this home and that the infection may have been from client activities on 12/18/22. DSP informed LPA that they were working on 12/19/22 but C1 did not tell DSP about the baked dessert item or about their infection. Furthermore, staff confirmed that a client activity from 12/18/22 could have resulted in C1's infection.

LPA reviewed pertinent records on this day. No deficiencies were cited during today's visit. This report was reviewed with and a copy was provided to the Ms. Hurado
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE: DATE: 01/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/23/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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