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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607012
Report Date: 08/11/2025
Date Signed: 08/11/2025 05:45:26 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/11/2025 and conducted by Evaluator Evelin Rios
COMPLAINT CONTROL NUMBER: 31-AS-20250811110935
FACILITY NAME:JBM RESIDENCE HOME, INC.FACILITY NUMBER:
197607012
ADMINISTRATOR:JOSEPHINE B. MIRANDAFACILITY TYPE:
740
ADDRESS:3205 ARIOUS WAYTELEPHONE:
(661) 522-1968
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:6CENSUS: 4DATE:
08/11/2025
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Josephine B. MirandaTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Facility air conditioning is in disrepair.
INVESTIGATION FINDINGS:
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On 08/11/2025 Licensing Program Analyst (LPA) Evelin Rios arrived to the facility to conducted an initial complaint visit to investigate the above mentioned allegation. Upon arrival, LPA was greeted by staff #1 (S1) and was granted access. LPA met with Licensee, Josephine Miranda and LPA explained the purpose of todays visit. Entrance interview conducted.

Allegation: Facility air conditioning is in disrepair. In regards to the allegation it was reported the facility's air conditioner (AC) is not working. To investigate the allegation, from 12:00 p.m., to 1:06 p.m., LPA conducted a physical plant tour of the facility. While conducting the tour LPA interview the licensee, a resident's visitor and two (02) out of four (04) residents. LPA obtained copies of text message communication between the hired AC company and the licensee regarding scheduled visits, receipt of payment for the July 18th visit, resident roster and staff schedule. According to the administrator the AC had stopped working previously on July 18th, 2025 but was fixed the same day by a technician.
(Continue to LIC9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2025
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 3
Control Number 31-AS-20250811110935
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: JBM RESIDENCE HOME, INC.
FACILITY NUMBER: 197607012
VISIT DATE: 08/11/2025
NARRATIVE
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(Continued from LIC9099) Then sometime on the first week of August it stopped working and a technician visited the facility again on August 5th, 2025 and placed an order for an AC part. According to text communication between the company and the licensee a technician will be out to the facility tomorrow, August 12th, 2025 between 8AM and 12PM to fix the AC. Interview with resident #1 (R1) and resident #2 (R2) stated not verbatim that they did not feel uncomfortable with the temperature in the facility. Interview with R2's visitor stated they believed the AC was not working during their last visit, Thursday, August 7th, 2025, but had also not felt uncomfortable with the temperature in the facility. According to the licensee resident #3 (R3) did complain the facility was too hot and was upset that AC was not working. According to the licensee a portable swamp cooler was purchased for R3's bedroom. LPA Rios observed the portable unit in R3's bedroom and the facility's thermostat was observed inoperable. LPA also observed the ceiling fans on in residents' bedrooms. Resident #4 (R4) was sleeping during today's visit. The temperature outside at 1:34 p.m., based on the Weather.com is 105 degrees Fahrenheit. Based on interviews and observation this allegation is deemed Substantiated.

Deficiency cited (refer to LIC9099-D). Exit interview conducted. Appeal rights provided. Report signed and copy provided.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20250811110935
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: JBM RESIDENCE HOME, INC.
FACILITY NUMBER: 197607012
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/11/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/15/2025
Section Cited
CCR
87303(b)(2)
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(b) A comfortable temperature for residents shall be maintained at all times. (2) The facility shall cool rooms to a comfortable range... or in areas of extreme heat to 30 degrees F less than the outside temperature. This requirement is not met as evidenced by:
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The licensee will email LPA Rios the receipt of service showing the air-conditioning (AC) was fixed. Licensee will purchase portable AC units for each room with a residnet if the AC is not working on August 12, 2025.
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Based on LPA's interviews and observation the facility's air conditioning system was observed to be inoperable which poses an potential Health, Safety or Personal Rights risks to persons 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: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3