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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565802413
Report Date: 02/10/2025
Date Signed: 02/10/2025 02:43:37 PM

Document Has Been Signed on 02/10/2025 02:43 PM - 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:JD RESIDENTIAL CAREFACILITY NUMBER:
565802413
ADMINISTRATOR/
DIRECTOR:
JUNIO, JOJI JOSEFA BFACILITY TYPE:
735
ADDRESS:2199 MARVEL AVETELEPHONE:
(310) 435-9822
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93065
CAPACITY: 6CENSUS: 4DATE:
02/10/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:06 PM
MET WITH:Joji JunioTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced Case Management – Incident visit at approx 02:07 p.m. for the purpose of investigating a self-reported incident report. Upon arrival, LPA met with Administrator  Joji Junio and explained the reason for the visit.
 
On 01/25/2025  - Staff #1 (S1)  assisted Client #1 (C1)  with a shower. S1 observed a bite on left outer elbow. Bruise on left inner upper armpit that was about the size of 3 quarters and a bite on the right outer upper arm about the size of 2 quarters.
 
LPA conducted physical plant, interviewed staff and reviewed and obtained copies of pertinent documentation relevant to the investigation.
 
No immediate health and safety concerns were observed during the visit. LPA has determined further investigation is needed and will return at a later date if required.
 
Exit interview conducted. A copy of the report was issued.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE: DATE: 02/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/10/2025
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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