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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565802466
Report Date: 08/02/2023
Date Signed: 08/02/2023 07:09:35 PM

Substantiated


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
03/07/2023 and conducted by Evaluator Zabel Chochian
COMPLAINT CONTROL NUMBER: 29-AS-20230307111341
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:
08/02/2023
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Lorenzo BanasTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Staff training requirements not met
Licensee not meeting the minimum staffing ratio
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Zabel Chochian conducted a subsequent complaint visit today regarding above allegations. LPA met with staff upon arrival and later with Mr. Ramon Banas. Administrator Lorenzo Banas was assisting a client to a doctors appointment. Reason for visit was discussed. During today’s visit, the LPA reviewed staff records from 10am-11:45am. Mr. Lorenzo Banas arrived to facility at approximately 12:15pm. LPA discussed the staff records review conducted today and at the time of the initial visit on 03/16/2023. Based on the review of staff records and interview with Administrator it was revealed that the staff training requirements were not met for 2022-2023. Administrator stated that he continued training with staff this year and will ensure training requirements are met for staff scheduled to work in the home. Regarding allegation Licensee not meeting the minimum staffing ratio: Administrator acknowledged understanding of the minium staffing ratio requirement for the facility (1:1 staff is additional staff and is not to be counted toward the minimum hours per week of additional staff). Facility shall have two (2) 1:1 staff for the two (2) clients and one (1) additional staff. Based on the interviews and records reviewed allegations are deemed substantiated at this time. Deficiencies cited. Exit interview held.Copy of report/appeal rights issued.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023
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 3
Control Number 29-AS-20230307111341
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/02/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/02/2023
Section Cited
CCR
85065.5(a)(1)
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Day Staff-Client Ratio (1) For Regional Center clients, staffing shall be maintained as specified by the Regional Center but no less than one direct care staff to three such clients. This requirement is not met as evidenced by:
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Administrator has since discussed with Regional Center the Staff-Client Ratio and the minimum hours needed to operate the facility accordingly. Facility staff schedule observed at the facility during todays visit. Three staff observed on duty during LPAs visit today.
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Based on interview and record review, the licensee failed to follow staffing ratios as specified by the Regional Center, which poses an immediate health and safety risk to clients in care.
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Type B
08/10/2023
Section Cited
CCR
85165(b)123
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Emergency Intervention Staff Training (b) Staff who use, participate in, approve or provide visual checks of manual restraint or seclusion, shall have a minimum of sixteen hours of emergency...having successfully completed the training...
This requirement is not met as evidenced by
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Administrator stated that they will conduct the training starting this Saturday. Submit copy of certificates to LPA by 08/10/2023.
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Based on interview and record review, four (4) of six (6) staff records reviewed did not have required CPI training; certificates were expired, which poses an immediate safety and personal rights risk to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
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
03/07/2023 and conducted by Evaluator Zabel Chochian
COMPLAINT CONTROL NUMBER: 29-AS-20230307111341

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:
08/02/2023
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Lorenzo BanasTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Staff do not have TB clearance
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Zabel Chochian conducted a subsequent complaint visit today regarding above allegation. LPA met with staff upon arrival and later with Mr. Ramon Banas. Administrator Lorenzo Banas was assisting a client to a doctors appointment. Reason for visit was discussed.
During today’s visit, the LPA reviewed staff records from 10am-11:45am. Mr. Lorenzo Banas arrived to facility at approximately 12:15pm. LPA conducted staff records review on 03/16/2023 from 11am-1pm and today from 10am-11:45am. Interview was also conducted with a credible witness who stated that during their visit to the facility in 3/2023 staff #3 did not have a TB clearance. The LPA conducted a visit on 3/16/2023 and reviewed staff records. LPA generated a Case Management report and cited for not having required staff records on file. Staff health screening and TB clearance was missing from the file during initial visit review. However Administrator did locate the records and it was confirmed that staff #3 and other staff did have the TB clearance. Staff #3's TB observed on file and dated 10/01/2018. Based on interviews conducted and records reviewed there is not sufficient evidence to support allegation that "Staff do not have TB clearance" at this time. Therefore, allegation is deemend unsubstantiated. Exit interview held. Copy of report issued.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3