198600173-4-21-2026-31-AS-NMAN-DUFLFW-20260526084350

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600173
Report Date: 04/21/2026
Date Signed: 04/21/2026 05:52:32 PM

Substantiated

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
09/16/2025 and conducted by Evaluator Antonia Alvizar-Ettima

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20250916210356

FACILITY NAME:	J-J ADULT CARE HOME		FACILITY NUMBER:	198600173
ADMINISTRATOR:	CATHERINE ABALOS		FACILITY TYPE:	735
ADDRESS:	1233 BOYNTON STREET		TELEPHONE:	(818) 243-0628
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91205
CAPACITY:	6	CENSUS: 5	DATE:	04/21/2026
		UNANNOUNCED	TIME BEGAN:	03:15 PM
MET WITH:	Administrator,Catherine Abalos & Lead Direct Support Prefessional (DSP), Gertrudes Armanento		TIME COMPLETED:	06:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff does not properly dispose feces

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

At 3:15p.m., Licensing Program Analyst (LPA) Antonia Alvizar- Ettima conducted an unannounced subsequent visit to deliver the finding for the above noted allegation. LPA was greeted by the Lead Direct Support Professional (DSP), and the purpose of the visit was explained. The Administrator later joined the visit.

During this visit at 3:25p.m., LPA and Lead DSP conducted a physical plan tour and did not observe any immediate health and safety issues.

During initial visit on 09/19/25 at 10:45a.m., LPA requested and obtained copies of the facility’s client and staff rosters. Between 11:25a.m. – 2:15p.m., LPA conducted interviews with the Administrator, two (2) staff and two (2) out of five (5) five clients including client #1 (C1). Three (3) clients were not interviewed due to medical condition. At about 3:05p.m. LPA received Daily Notes, Staff Contact Information and other pertinent information.
Cont. on LIC 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2026

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-20250916210356

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: 04/21/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Cont. from LIC 9099

Prior to this visit on 04/18/26 LPA reviewed the information, and the documents previously obtained from
the facility.

Staff does not properly dispose of feces

It was alleged that Staff #1 (S1) left a bucket with human feces in a bucket inside the sink of a common area. Staff interviews conducted revealed that S1 acknowledged that a bucket containing waste was placed in the sink area temporarily and was not immediately disposed of in accordance with proper sanitation procedures. Staff #2 (S2) indicated that waste disposal procedures require immediate disposal in designated areas and confirmed that placing waste in a common sink area is not consistent with facility protocol. The Administrator acknowledged the incident occurred and confirmed that S1 failed to follow proper procedures for disposal of human waste. Interview with Client #1 (C1) confirmed the information provided. Additional client interviewed did not express concerns related to the allegation. LPA observed that the sink is in a common area accessible to clients in care. The presence of human waste in this area poses a potential health and sanitation risk. Records reviewed confirm the information provided by facility staff.

Based on interviews and record review, the preponderance of evidence standard has been met, therefore the above allegation, “Staff does not properly dispose of feces” is deemed SUBSTANTIATED at this time.

Per the California Code of Regulations, Title 22, Division 6, Chapter 6, the following deficiency was observed and cited during the visit (See LIC 9099-D).

Exit interview conducted. A copy of the report and appeal rights were provided.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 31-AS-20250916210356

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/21/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/05/2026 Section Cited CCR 85095.5(2)(A)	1 2 3 4 5 6 7	85095.5 (2)(A) Infection Control Requirements (2) Environmental cleaning...at a minimum, as follows: (A) Surfaces such as... sinks, counters disinfected when these surfaces are contaminated...visibly... body fluids... infectious material. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The Administrator agrees to retrain staff on proper waste disposal procedures, ensure immediate compliance, and maintain sanitation standards. Administrator will conduct In-Service training & documentation will be submitted to CCLD by POC due date.
	8 9 10 11 12 13 14	Based on interviews and records reviewed, the licensee did not comply with the section cited above. The licensee failed to ensure proper disposal of human waste when staff placed a bucket containing feces in a common area sink, posing a health and sanitation risk to clients in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 3