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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565802466
Report Date: 04/26/2023
Date Signed: 04/26/2023 04:13:33 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
09/30/2022 and conducted by Evaluator Elsie Campos
COMPLAINT CONTROL NUMBER: 29-AS-20220930114107
FACILITY NAME:JJ RESIDENTIAL CARE IIFACILITY NUMBER:
565802466
ADMINISTRATOR:BANAS, LORENZOFACILITY TYPE:
735
ADDRESS:1542 DEANNA AVETELEPHONE:
(805) 791-3260
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93065
CAPACITY:4CENSUS: 4DATE:
04/26/2023
UNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Lorenzo BanasTIME COMPLETED:
04:20 PM
ALLEGATION(S):
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Staff have not been treating resident with dignity and respect
Staff have been striking a resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Elsie Campos arrived unannounced for a subsequent complaint visit to investigate the above allegations at 2:45 p.m. The LPA met with staff and explained the reason for the visit. Administrator Lorenzo Banas arrived shortly thereafter.

On 10/4/2022, the LPA interviewed residents at 11:52 a.m. and 12:06 p.m., interviewed staff at 12:12 p.m., 12:21 p.m. and 12:34 p.m., collected pertinent documents at 12:50 p.m. During today’s visit the LPA conducted a physical plant tour at 2:50 p.m. to ensure there are no health and safety concerns. Conducted interviews with residents at 2:55 p.m., 2:58 p.m., 3:03 p.m. and 3:07 p.m. Conducted interviews with staff at 3:10 p.m. and delivered the findings.

Regarding the allegation: Staff have not been treating resident with dignity and respect
On the allegation of ‘Staff failed to treat residents with dignity and respect’, the complainants concern is
**Continued on LIC 9099-C**
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Elsie Campos
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023
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-20220930114107
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: JJ RESIDENTIAL CARE II
FACILITY NUMBER: 565802466
VISIT DATE: 04/26/2023
NARRATIVE
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that staff are disrespectful to residents by being loud and yelling. To investigate the allegation the LPA conducted resident interviews on 10/04/2022 and 4/26/2023. Statements from resident #1 (R1 )and resident #2 (R2) yielded inconsistent. Residents’ interviews were inconsistent and did not confirm that staff have not treated them with dignity and respect. Additionally, R1 and R2 confirmed that there have been no issues with staff. Additional interviews with resident #3 (R3) and resident #4 (R4) indicated that there are no issues with staff as they feel that staff treat them with dignity and respect. Staff interviews denied not treating residents with dignity and respect, even at times when residents are disrespectful. Staff #2 (S2) confirmed that each resident has their own personality and that residents have different responses and while staff might be tougher with one resident or another it is based on the residents personality and done with respect.

Based on the information obtained through interviews, while this allegation may or may not have happened there is insufficient evidence to support the allegation that ‘Staff failed to treat residents with dignity and respect’. Therefore, this allegation is Unsubstantiated at this time.

Regarding the allegation: Staff have been striking resident


On the allegation of ‘Staff have been striking resident’, the complainants concern is that Resident #1 (R1) had been heard yelling at staff to not hit them. To investigate the allegation the LPA conducted resident interviews on 10/04/2022 and 4/26/2023. Statements from resident #1 (R1) and resident #2 (R2) yielded inconsistent. An interview with resident #2 (R2) revealed that they heard R1 yelling for staff to stop hitting them however, R2 did not physically see staff hitting R1. R1 revealed that although staff have come close to their face while in escalated discussions they have never placed their hands on them. An interview with R1 revealed that they cannot get along with staff at the facility. R1 did not have any physical marks on them at the time of the visit on 10/4/2022 or 4/26/2023 and although he claims to have been hit in the arm by Staff #1 (S1) there was no mark left behind. Statements on 4/26/2022 from R1 and R2 denied claims that staff have ever hit them and there are no longer any issues. Interviews with resident #3 denied claims that they have ever been hit by staff or witnessed staff hitting any other residents. Staff interviews denied that they have ever hit a resident even at times when residents have been physically combative.

Based on the information obtained through interviews, while this allegation may or may not have happened there is insufficient evidence to support the allegation that ‘Staff have been striking resident’. Therefore, this allegation is Unsubstantiated at this time.

No immediate health and safety concerns observed during today's visit. No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Elsie Campos
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023
LIC9099 (FAS) - (06/04)
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