567609848-9-9-2022-29-AS-JAPL-CJMN74-20220926101206

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 567609848
Report Date: 09/08/2022
Date Signed: 09/09/2022 10:33:07 AM

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
11/16/2021 and conducted by Evaluator Teresa Camara

COMPLAINT CONTROL NUMBER: 29-AS-20211116151811

FACILITY NAME:	JJ RESIDENTIAL CARE III		FACILITY NUMBER:	567609848
ADMINISTRATOR:	BANAS, AMELIA/JUNIO, RAMON		FACILITY TYPE:	735
ADDRESS:	810 GREENBRIAR AVENUE		TELEPHONE:	(805) 422-8659
CITY:	SIMI VALLEY	STATE: CA	ZIP CODE:	93065
CAPACITY:	4	CENSUS: 4	DATE:	09/08/2022
		UNANNOUNCED	TIME BEGAN:	09:56 AM
MET WITH:	Ramon Junio		TIME COMPLETED:	12:10 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident was incorrectly charged for a meal at the facility.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Teresa Camara conducted a subsequent complaint investigation visit. LPA met with Administrator Ramon Junio.

LPA conducted an interview with staff at 11:33 a.m. and the administrator at 11:41 a.m. Client 1 (C1) no longer lives at the facility. Based on interviews with staff, C1 would save copies of mail flyers which had items C1 was interested in purchasing. These flyers were usually for restaurants. When C1 received P&I money C1 would bring out the flyer of interest and point at it to staff until they agreed to take C1 to the restaurant to pick up food. On the day in question, C1 wanted to purchase pizza so staff took C1 to get pizza. C1 ate half of a large pizza and saved the other half for later. Staff indicated C1's conservator took the receipt for the pizza from the facility and staff were not able to obtain a copy of the receipt before it was removed from the facility.

(continured on 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022

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-20211116151811

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 III	FACILITY NUMBER: 567609848
	VISIT DATE: 09/08/2022

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
26
27
28
29
30
31
32

According to staff and the administrator, C1 and all clients are offered meals and snacks, however sometimes clients prefer to purchase other food items when they receive their P&I money. If other clients went to go out to a restaurant or to purchase other food items and C1 was left out, C1 would get very sad and sometimes cry.

After the day when C1 purchased a large pizza, C1's conservator insisted C1 could not use P&I money to purchase full meals. Therefore, when the other clients would go to restaurants the administrator Amelia Banas would pitch in money so C1 could also purchase something at the restaurant and not be left out in order to maintain C1's personal rights.

Based on the information obtained in interviews, C1 was offered meals and snacks by staff but C1 occasionally chose to purchase other food. Therefore the allegation that C1 was incorrectly charged for a meal at the facility is deemed Unsubstantiated at this time.

Exit interview conducted with Administrator. A copy of the report was emailed to Administrator.

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 2