198600173-10-1-2025-31-AS-NMAN-DNZRJZ-20251203120447

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600173
Report Date: 10/01/2025
Date Signed: 10/01/2025 11:24:46 AM

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
09/29/2025 and conducted by Evaluator Michael Cava

COMPLAINT CONTROL NUMBER: 31-AS-20250929153221

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:	10/01/2025
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Gertrude Armento		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff are not mitigating the spread of infectious outbreaks in the facility

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Michael Cava conducted a complaint visit at the facility to investigate the above allegation. LPA met with Gertrude Armento, staff/team lead, and advised her of the complaint. Today's investigation consisted of interviews with staff and residents, a physical plant inspection and record review.

In regards to the complaint, it's being reported that Resident 1 (R1) is ill, and might be infected with the COVID-19 virus. R1 was observed to be exhibiting symptoms of cough and has a habit of spitting in common areas. It's alleged that staff is not implementing appropriate precautions or protocols to prevent the spread of this infection, as several staff and residents have begun to show symptoms.

An interview with three (3) of three staff, conducted at around 10:00am to 10:30 am, deny the allegation. Staff stated that facility does have an infection control plan, which is followed if there are any signs or

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2025

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-20250929153221

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: 10/01/2025

NARRATIVE

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symptoms of COVID-19. Pertaining to the allegation, R1's cough is not due to COVID-19, but it was a case of seasonal allergies. Staff did say, R1 does, and always has a habit of spitting in common areas, which they try to address. As a precaution to the symptoms that R1 was exhibiting, the licensee administered COVID-19 test to all staff and residents on 09/29/25, and the infection control protocols of sanitizing, wearing masks, and minimal isolations limited to resident rooms were put in place. Results of these tests are negative, and facility is back to normal operations as usual.

Between 10:30am to 10:50 am, LPA conducted interviews with two (2) of the five residents. Interviews with two of the five residents do not corroborate with the allegation. LPA could not hold an interview with Resident 1 (R1) and Resident 3 (R3) because they were at program. Resident 5 (R5) is non-verbal.

Between 10:50am to 11:00am, LPA conducted a record review and observed the facility's infection control plan. LPA reviewed R1's records and observed a doctor's note that clears R1 to return to program on 09/22/25. Review of R1's records also indicate a doctor appointment for a wellness visit made on 09/17/2025. The assessment indicates seasonal allergies. In addition to reviewing R1's records, LPA reviewed the negative test results for all residents and staff. Copies of R1's records and pictures of the test results were taken during the visit.

LPA's brief walk through of the physical plant (conducted between 11:00am to 11:15am), was observed to be clean, safe and sanitary. No staff or residents were observed to be coughing at the time of the LPA's visit

Based on the information obtained, there was insufficient evidence to prove the allegation of staff not mitigating the spread of infectious outbreaks in the facility. Therefore, the allegation is deemed Unsubstantiated at this time.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2025

LIC9099 (FAS) - (06/04)

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