198600173-2-28-2026-31-AS-NMAN-DS5RRX-20260313131549

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600173
Report Date: 02/28/2026
Date Signed: 02/28/2026 12:29:01 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
08/25/2025 and conducted by Evaluator Tihesha Smith

COMPLAINT CONTROL NUMBER: 31-AS-20250825122944

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:	02/28/2026
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Catherine Abalos- Administrator		TIME COMPLETED:	12:35 PM

ALLEGATION(S):

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Staff are using the facility for their personal accommodations
Staff are sleeping while providing care and supervision

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tihesha Smith conducted unannounced subsequent complaint visit to the facility to complete an investigation for the above allegations. The administrator was not present at the facility and was contacted by staff. The administrator arrived approximately one hour later and LPA Smith disclosed the purpose of the visit.

Staff are using the facility for their personal accommodations
Staff are sleeping while providing care and supervision

Licensing Program Analyst (LPA), Angelica Segovia conducted an unannounced initial complaint visit to the facility on 8/25/2025 at approximately 10:30 AM. LPA Segovia requested the census, clients and staff roster including conducting a physical plant tour at 11:00 AM.

(cont to page 9099C)

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2026

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-20250825122944

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: J-J ADULT CARE HOME	FACILITY NUMBER: 198600173
	VISIT DATE: 02/28/2026

NARRATIVE

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(Cont from 9099)

On 02/22/26, LPA Tihesha Smith reviewed case information and interviewed the administrator via phone on 02/26/26. Video footage revealed garage had a makeshift sleeping area with staff #1 (S1) sleeping on a bed during visible daylight in video. Interview with administrator revealed Staff #2 and Staff #3 used living room area to make beds on the sofa. The administrator revealed they have already addressed the violations with the staff involved and staff #1-3 are no longer employed at the facility. The administrator revealed during today's visit that S3 worked spilt shift from 6am to 2pm and 2pm to 7pm as noted on LIC 500. During visit, LPA Smith toured facility and garage. The garage no longer has makeshift sleeping quarter and LPA Smith confirmed S1-S3 no longer at facility.

Based on case information received and interview with the administrator there is sufficient information to verify the allegations Staff are using the facility for their personal accommodations and Staff are sleeping while providing care and supervision. Therefore, the allegations are deemed SUBSTANTIATED at this time.

Deficiencies cited on 9099D

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

Exit interview conducted and copy of this report provided.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2026

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20250825122944

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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: 02/28/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 03/01/2026 Section Cited CCR 85087(a)(3)	1 2 3 4 5 6 7	Licensee/administrator will review regulation submit plan of correction to prevent any future issues. POC date: 03/01/26	1 2 3 4 5 6 7	Licensee/administrator will review regulation submit plan of correction to prevent any future issues. POC date: 03/01/26
	8 9 10 11 12 13 14	Based on information obtained through interviews and video S1 -S3 used garage and/or living room to make beds. This poses a health, safety or personal rights risk to persons in care.	8 9 10 11 12 13 14	Per Licensee/administrator staff no longer working at facility. LPA did not see individuals in facility at time of visit.
Type A 03/01/2023 Section Cited CCR 85078	1 2 3 4 5 6 7	Section 85078(a)(1) : [...]The licensee shall ensure that clients receive care and supervision as necessary to meet their needs.	1 2 3 4 5 6 7	Licensee/administrator will review regulation submit plan of correction to prevent any future issues. POC date: 03/01/26
	8 9 10 11 12 13 14	Base on Based on information obtained through interviews and video S1 -S3 used garage and/or living room to make beds and sleep. This poses a health, safety or personal rights risk to persons in care.	8 9 10 11 12 13 14	Per Licensee/administrator staff no longer working at facility. LPA did not see individuals in facility at time of visit.

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: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2026

LIC9099 (FAS) - (06/04)

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