567609848-8-12-2025-29-AS-KBUY-DKYJDD-20250828065723

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 567609848
Report Date: 08/12/2025
Date Signed: 08/12/2025 02:32:59 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
08/05/2025 and conducted by Evaluator Brian Balisi

COMPLAINT CONTROL NUMBER: 29-AS-20250805140736

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:	08/12/2025
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Amelia Banas		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff grabbed resident by the neck

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) conducted an unannounced subsequent complaint visit to continue the investigation of the allegation listed above. Upon arrival LPA met with staff and explained the reason for the visit. Administrator Amelia Banas arrived shortly after.

On 08/07/2025, LPA initiated the investigation between 09:30 a.m. - 12pm. LPA conducted physical plant, interviewed staff, client and reviewed and obtained copies of pertinent documentation relevant to the investigation. Also on 08/07/2025, LPA conducted collateral visits to ARC VC - Chochran # 565801424 and Simi Oaks Counseling Group # 565800884 to interview clients attending their day programs. Today LPA conducted physical plant, interviewed staff, client and reviewed and obtained copies of additional pertinentt documentation relevant to the investigation.

Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20250805140736

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: 08/12/2025

NARRATIVE

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It was reported that "Staff grabbed resident by the neck" as it was alleged on 07/29/2025 at approx 3am, Staff #1 (S1) redirected Client #1(C1) from the bathroom by forcibly grabbing hold of C1's neck. Interviews conducted and records review revealed that four (4) out of (4) clients have never observed any staff grab any clients neck with excessive force. Two (2) out of the (4) clients stated on 07/29/2025, they observed S1 assist C1 back to C1's bedroom, but both stated they do not recall if staff placed their hands in an aggressive manner on C1. Both clients continued to state that C1 did not appear to be in distress by S1 while S1 assisted C1 back to C1's room. Furthermore LPA's interview with C1 revealed that C1 could not recall S1 placing S1's hand on any parts of C1's body, but C1 stated if they were uncomfortable in any way with S1 they would have said something to S1. All clients interviewed did not express any concerns for their health and safety with the current staff at this time. LPA's interview with four (4) staff revealed that all (4) have never observed any staff place their hands around the neck of any client in care. All staff did not express any concerns for client safety with any staff at this time. Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegation “Staff grabbed resident by the neck” is deemed Unsubstantiated at this time.

Exit interview conducted and copy of report issued.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2025

LIC9099 (FAS) - (06/04)

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