198600173-9-3-2025-31-AS-TAGD-DLBRYE-20250908132610

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600173
Report Date: 09/03/2025
Date Signed: 09/03/2025 02:23:39 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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
08/20/2025 and conducted by Evaluator Angelica Segovia

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20250820101203

FACILITY NAME:	J-J ADULT CARE HOME		FACILITY NUMBER:	198600173
ADMINISTRATOR:	JOSE & JEAN TIMBOL		FACILITY TYPE:	735
ADDRESS:	1233 BOYNTON STREET		TELEPHONE:	(818) 243-0628
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91205
CAPACITY:	6	CENSUS: 5	DATE:	09/03/2025
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Catherine Abalos- Administrator		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff did not treat client with dignity and respect.
Staff did not ensure the facility was kept clean, safe and in sanitary condition.
Staff did not follow client’s dietary restrictions.
Staff did not keep client’s medical information confidential.

INVESTIGATION FINDINGS:

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On 9/03/2025 at approximately 1:00 PM, Licensing Program Analyst (LPA) Angelica Segovia conducted an unannounced subsequent complaint visit to the facility. LPA was greeted by staff and stated the reason for their visit was to conduct additional interviews and deliver the findings of the complaint. The Administrator, Catherine Abalos was unavailble to attend today's visit and designated the lead staff member to assist with today's visit.

To investigate the allegation(s), on 8/28/2025 at approximately 10:30 AM, LPA conducted a physical plant tour. By 11:40 AM, LPA requested relevant documentation. From 11:30 AM to 2:30 PM, LPA attempted interviews with five (5) clients (C1-C5), six (6) staff members (S1-S6) and conducted record review.

(Continue to LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE:	DATE: 09/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025

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 31-AS-20250820101203

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: J-J ADULT CARE HOME	FACILITY NUMBER: 198600173
	VISIT DATE: 09/03/2025

NARRATIVE

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Regarding the allegation: Staff did not treat client with dignity and respect. It was alleged that a staff member made inappropriate statements regarding a client’s nationality. To investigate the allegation, LPA attempted interviews with five (5) clients and five (5) staff members. LPA’s interview with C1 revealed that S2 told them, “So you are Mexican? Trump is after you” and proceeded to laugh. C1 stated they felt hurt and were not laughing along with S2. LPA attempted to interview C2, C3 and C4 but due to their inability to communicate due to various medical reasons, LPA terminated the interviews. LPA attempted to interview C5, but they were not present and could not be contacted.

LPA’s interview with four (4) of the five (5) staff members stated they have not been disrespectful towards clients, nor have they witnessed others do so. LPA’s interview with S2 revealed that they had no recollection of making such remarks regarding C1’s nationality, but did acknowledge they apologized in order to defuse the situation.

Based on interviews, the allegation may have occurred, however there is not a preponderance of evidence to prove the alleged allegation did or did not occur, therefore the allegation is UNSUBSTANTIATED at this time.

Regarding the allegation: Staff did not ensure the facility was kept clean, safe and in sanitary condition. It was alleged that the facility has not been kept in sanitary and safe conditions. To investigate the allegation, LPA interviewed one (1) client and one (1) staff member. LPA’s interview with C1 revealed they have found rodent feces, poisonous traps and exposed sharp glass within the facility. When presented with evidence, LPA was unable to determine the authenticity of such evidence presented to be factual.

During LPA’s physical plant tour, LPA did not observe any sharp objects exposed nor protruding from the ground up within either the front yard or back of the yard. LPA observed the outside of the facility to be neat, clean and organized. During LPA’s tour of the inside of the facility, LPA did not observe any rodents or pest control devices. LPA conducted bedroom checks where the rooms were observed to be in proper condition and free of pests.

LPA’s interview with S1 revealed that when C1 expressed their concerns over the rodents, they scheduled an appointment with pest control services as a precautionary measure. LPA’s record review confirmed that pest control services were scheduled and conducted at the facility on 8/20/2025.

Based on LPA’s interviews, observations and record review, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. (Continue to LIC 9099-C)

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE:	DATE: 09/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20250820101203

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: J-J ADULT CARE HOME	FACILITY NUMBER: 198600173
	VISIT DATE: 09/03/2025

NARRATIVE

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Regarding the allegation: Staff did not follow client’s dietary restrictions. It was alleged that staff cross contaminated C1’s plant-based food. To investigate the allegation, LPA conducted interviews with three (3) staff members. Interview with all three staff confirmed they clean and change out the baking liners after each use. During LPA’s physical plant tour, LPA observed the conventional oven including pots and pans to be clean. LPA observed the oven to be equipped with disposable foil paper. Additionally, LPA observed staff to change out the cooking liners and wash all kitchen utensils after each use. LPA’s record review of C1’s Individual Program Plan (IPP) revealed they did not have any dietary restrictions ordered by a Physician nor was there documentation of their preference in food. Further record review of C1’s Admission Agreement confirmed the services to be provided would entail a, “…Modified diet, if prescribed”.

Based on interviews, observation and record review, C1 did not have a prescribed physicians’ order indicating a dietary restriction nor was C1’s food preference noted on their IPP, therefore, the allegation is UNSUBSTANTIATED at this time.

Regarding the allegation: Staff did not keep client’s medical information confidential. It was alleged that C1’s right to privacy was violated when staff spoke of C1’s medical related information to another client. To investigate the allegation, LPA conducted interviews with two (2) clients and four (4) staff members. LPA’s interview with one (1) of the two (2) clients revealed they have not witnessed staff disclosing clients’ medical information to other clients. LPA’s interview with all staff members stated that they have not witnessed any staff members discussing clients’ private information to other clients in care. During LPA’s physical plant tour, LPA observed clients’ files with confidential information to be kept locked in a filing cabinet located near the staff reception area. LPA observed the cabinet to be secure and inaccessible.

Based on interviews and observations, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

No immediate health and safety hazards observed during the time of the visit.

An exit interview was conducted, and a copy of this report was provided to the lead staff member.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE:	DATE: 09/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025

LIC9099 (FAS) - (06/04)

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