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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 567609848
Report Date: 07/03/2025
Date Signed: 07/03/2025 02:23:51 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
06/25/2025 and conducted by Evaluator Kelly Dulek
COMPLAINT CONTROL NUMBER: 29-AS-20250625165130
FACILITY NAME:JJ RESIDENTIAL CARE IIIFACILITY NUMBER:
567609848
ADMINISTRATOR:BANAS, AMELIA/JUNIO, RAMONFACILITY TYPE:
735
ADDRESS:810 GREENBRIAR AVENUETELEPHONE:
(805) 422-8659
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93065
CAPACITY:4CENSUS: 4DATE:
07/03/2025
UNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Amelia BanasTIME COMPLETED:
02:28 PM
ALLEGATION(S):
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Staff did not provide a meal to a client in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kelly Dulek, along with Investigations Branch (IB) Investigator Rocio Flores conducted an unannounced complaint visit to investigate the allegation listed above. Upon arrival, LPA and Investigator met with staff and explained the reason for the visit. Administrator Amelia Banas arrived shortly after. Entrance interview conducted.

At 09:45AM, LPA, Investigator and facility staff toured the facility. LPA and Investigator conducted an interview with the Administrator at 09:52AM, staff and client interviews from 11:20AM to 12:25PM. LPA and Investigator also reviewed relevant documents including but not limited to: client files and staff training; LPA obtained copies of pertinent documents. The following was then determined:

Report Continued on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025
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-20250625165130
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: 07/03/2025
NARRATIVE
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The complaint alleges that Client #1 (C1) had not gotten their lunch before C1's family member picked them up at 01:50PM. LPA interviewed staff and clients, who all stated lunch time is typically between 11:30AM and 12:00PM. Staff stated that sometimes C1 does not want their lunch at that time or chooses not to eat the lunch provided at that time and will wait until they want the food. On the date of the alleged incident, staff stated that C1 had eloped from the facility earlier in the day and that C1 did not want their food at lunchtime. All clients interviewed, including C1 stated they have never missed a meal or not been provided with food when requested. LPA and Investigator observed ample food in the facility, both perishable and non-perishable in all food groups. C1 stated that the staff take them to restaurants or they make food at the facility. C1 reported being very happy with the food. During today's visit, LPA observed staff prepare food for the clients and observed C1 eating lunch. C1 stated it was the best tuna sandwich they had ever had. The information obtained during the investigation did not include sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time.

No citations issued, Exit interview conducted. A copy of today's report was provided.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025
LIC9099 (FAS) - (06/04)
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