Senior Care Records.

Complaint Investigation Report

JJ Residential Care III, Simi Valley11/18/2021Licence 567609848

Census4
Date signed11/19/2021 08:35:06 AM
The inspector’s account

567609848-11-19-2021-29-AS-JAPL-CDUUNY-20220426154444

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 21731 VENTURA BLVD. #250

This is an official report of an unannounced visit/investigation of a complaint received in our office on

11/09/2021 and conducted by Evaluator Teresa Camara

COMPLAINT CONTROL NUMBER: 29-AS-20211109133011

Licensing Program Analyst (LPA) Teresa Camara conducted an initial complaint investigation visit. LPA was joined by Tri-Counties Regional Center Quality Assurance Specialist (QAS) Freddie Garcia. LPA and QAS met with back-up Administrator Ramon Junio and Administrator Amelia Banas.

LPA and QAS arrived at the facility at 11:23 a.m., conducted a brief facility tour accompanied by staff at 11:27 a.m., interviewed the Administrators starting at 11:34 a.m, and reviewed staff records at 01:05 p.m. All staff scheduled to work at the facility had all appropriate documentation and all had DOJ/FBI background clearances. All back-up staff for the facility also had appropriate documenttion and background clearances on file at the facility.

No deficiencies were observed. Exit interview conducted with Administrator. A copy of the report was emailed to Administrator.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction