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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600173
Report Date: 09/11/2025
Date Signed: 09/11/2025 01:42:16 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
09/04/2025 and conducted by Evaluator Mariana Agban
COMPLAINT CONTROL NUMBER: 31-AS-20250904131823
FACILITY NAME:J-J ADULT CARE HOMEFACILITY NUMBER:
198600173
ADMINISTRATOR:JOSE & JEAN TIMBOLFACILITY TYPE:
735
ADDRESS:1233 BOYNTON STREETTELEPHONE:
(818) 243-0628
CITY:GLENDALESTATE: CAZIP CODE:
91205
CAPACITY:6CENSUS: 5DATE:
09/11/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Catherine Abalos-AdministratorTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff behavior poses as a risk to the clients
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mariana Agban conducted an unannounced initial complaint visit to investigate the above allegation. LPA arrived at the facility and was granted access by staff#2. The administrator arrived shortly after, and LPA explained the reason for the visit. LPA conducted a physical plan tour to ensure the health and safety of the clients are protected and are in compliance with Title 22 Regulations.

Allegation: Staff behavior poses as a risk to the clients
It was alleged that on August 30, 2025, at 5:46 p.m., Client#1 (C1) witnessed Staff #1(S1) urinating in the facility's front yard. LPA requested and obtained copies of the Personnel Report, Client Roster, Staff#1 (S1) employee file, and Client#1 (C1) file. LPA interviewed 2 out of 5 clients and 4 staff members. Interview with C1 revealed that C1 has witnessed S1 urinating in the front yard multiple times. Interview with the Administrator confirmed the allegation.
(Continue on 9099C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025
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-20250904131823
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: 09/11/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/12/2025
Section Cited
HSC
569.58(a)(2)
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H&S1569.58(a)2- Conduct Inimical which is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the people of the State of California. This requirement is not met as evidenced by:
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Upon the Administrator's knowledge, S1 was immediately suspended. The administrator will schedule vendorized training for all staff by 09/12/25 and submit to CCL the vendor information and scheduled date of training. Training certifications to be submitted to CCL upon completion
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Based on information obtained, S1 engaged in conduct inimical that is inimical to the health, morals, and safety of the clients in care. S1 urinated in the facility's front yard. This poses an immediate health and safety risk to the clients 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: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20250904131823
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: 09/11/2025
NARRATIVE
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 The administrator stated that S1 was suspended immediately and later resigned. Based on information obtained, the allegation is deemed Substantiated at this time.

Exit interview conducted, citation issued, appeal rights given, a copy of this report signed and delivered.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3