<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361800195
Report Date: 07/31/2023
Date Signed: 07/31/2023 10:06:22 AM

Document Has Been Signed on 07/31/2023 10:06 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:
07/31/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:02 AM
MET WITH:Angella Eyitayo, DSPTIME COMPLETED:
10:08 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced Proof of Correction (POC) for a deficiency cited on form LIC9099-D issued on 07/13/2023.

During this visit LPA reviewed staff records. Staff interviews confirmed that lead staff keeps a copy of keys for staff records. LPA observations verified the following:
    • Deficiency 80066(a) cited per Title 22 Division 6 of the California Code of Regulations has been cleared. Licensee complied with the terms of the POC.

No new deficiencies were cited during today's visit. This report was reviewed with and a copy was provided to direct support staff (DSP) Crystal Jurado.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE: DATE: 07/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/31/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1