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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565801530
Report Date: 01/16/2025
Date Signed: 01/16/2025 11:53:26 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/08/2025 and conducted by Evaluator Emily Peraldi
COMPLAINT CONTROL NUMBER: 29-AS-20250108154753
FACILITY NAME:MJ FAMILY HOMEFACILITY NUMBER:
565801530
ADMINISTRATOR:MARI ONGFACILITY TYPE:
735
ADDRESS:4400 FROST DRIVETELEPHONE:
(805) 488-3179
CITY:OXNARDSTATE: CAZIP CODE:
93033
CAPACITY:6CENSUS: 6DATE:
01/16/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Jose OngTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff did not treat residents in care with dignity and respect.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Emily Peraldi along with Quality Assurance Specialist (QAS) Tri-Counties Regional Center Patrick Brown conducted an unannounced initial complaint visit to this facility. At 9:35 a.m., the LPA and QAS met with staff and explained the reason for the visit. At 9:50 a.m., one of the Administrators Jose Ong arrived at the facility.

Between 9:42 a.m. and 10:14 a.m., the LPA and QAS conducted interviews with four (4) staff and three (3) clients. At 10:00 a.m., the LPA received copies of pertinent documents. At 10:22 a.m., the LPA and QAS along with staff conducted a physical plant tour.

Continued on LIC 9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Emily Peraldi
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 29-AS-20250108154753
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: MJ FAMILY HOME
FACILITY NUMBER: 565801530
VISIT DATE: 01/16/2025
NARRATIVE
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Regarding the allegation: Staff did not treat residents in care with dignity and respect. Client interviews revealed that staff are nice. Interviews with clients did not voice any concerns regarding staff. Staff interviews revealed that no staff have witnessed or observed staff be disrespectful or rude to the clients in care. The information obtained during the investigation did not include evidence sufficient to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time.

Exit interview conducted. A copy of the report was provided.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Emily Peraldi
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2