198602570-10-19-2021-28-AS-CYEE-C8Y3XV-20211120173858

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602570
Report Date: 10/14/2021
Date Signed: 10/19/2021 03:02:59 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/05/2021 and conducted by Evaluator Elizabeth Irra

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210505113455

FACILITY NAME:	JRC PLATINUM CARE HOME		FACILITY NUMBER:	198602570
ADMINISTRATOR:	CANONES, JUNELLE		FACILITY TYPE:	735
ADDRESS:	2929 VAMANA STREET		TELEPHONE:	(909) 279-5485
CITY:	POMONA	STATE: CA	ZIP CODE:	91767
CAPACITY:	4	CENSUS: 4	DATE:	10/14/2021
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Facility Administrator		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff provided a client alcohol while in care.
Staff is interfering with a client's medication while in care.

INVESTIGATION FINDINGS:

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

****This LIC9099 supersedes and replaces the LIC9099 report issued on 05/12/2021**** The findings remain the same.

On 05/12/2021, Licensing Program Licensing (LPA) Elizabeth Irra conducted the initial 10-day complaint visit to investigate the above allegations. LPA was allowed entry to this home by Taj Marcelo (Direct Care Professional/DSP). During this investigation, at approximately 9:45 A.M., LPA interviewed Client #1 through Client # 3 (C-1 through C-3). LPA was unable to interview Client #4 (C-4) as C-4 is non-verbal. LPA also interviewed the Administrator, Staff #1 (S-1) and Staff #2 (S-2). m Staff # 3 (S-3) was unreachable. LPA was informed that (S-3) provided a 2 week notice to terminate employment at this facility prior to the 04/19/2021 incident in reference to the above allegations.

Refer to LIC 9099C for the continuation of this report.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021

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 28-AS-20210505113455

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: JRC PLATINUM CARE HOME	FACILITY NUMBER: 198602570
	VISIT DATE: 10/14/2021

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

Allegation: Staff provided a client alcohol while in care. During this investigation, LPA interviewed the Administrator, S-1, S-2, C-1, C-2 and C-3. LPA was unable to interview C-4 as C-4 is non-verbal. S-3 no longer works at this facility and was unreachable. During staff interviews, (1) Staff indicated that on 04/19/2021, at approximately 7:30 A.M, found an empty can of tea flavored Truly Hard Seltzer (which contains alcohol) on the kitchen counter and this was immediately reported to the Administrator. Per Administrator, staff were interviewed and no one was able to provide any information. Additionally, the can was showed to the clients and asked if they knew what this can was. Per Administrator, C-2 initially alleged that a Staff that works the night shift provides this drink when C-2 does not want to take medications at night. The Administrator immediately suspended the alleged staff pending investigation. Per Administrator, C-2 initially expressed to staff that C-2 did not have any knowledge that the drink had alcohol and “did not like it”. Per Administrator, during the interview with Pomona Police Department, C-2 informed the police officer that C-2 knew it was alcohol and that C-2 liked it and as result, Pomona Police Department did not pursue this matter. During LPAs interview, C-2 indicated that staff has not provided alcohol. C-2 has a history of fabricating and/or recanting stories and continued to change their story in regards to this allegation within the different individuals that interviewed C-2. Interviewed Staff indicated they have not observed nor heard of anyone consuming alcohol in this facility prior to this incident. Interviewed Staff indicated they are trained in mandated reporting, zero tolerance and clients rights. Interviewed Clients (C-1 through C-3) indicated staff do not provide any alcohol to them nor have they observed anyone drinking alcohol at this facility. LPA was unable to interview C-4 as C-4 is non-verbal. Staff and Client interviews and the inconsistency of C-2’s interviews do not corroborate this allegation.

Allegation: Staff is interfering with a client's medication while in care. During this investigation, LPA interviewed the Administrator, S-1, S-2, C-1, C-2 and C-3. LPA was unable to interview C-4 as C-4 is non-verbal. S-3 is no longer working at this facility and it is unreachable. Interviewed Staff indicated that the (1) client out of the (4) clients that alleged was given alcohol was taken to Urgent Care for an evaluation and there were no concerns noted. Interviewed Staff indicated they have not nor have observed any staff interfering with clients medications. Interviewed staff also indicated Clients are provided with their medication as prescribed. Interviewed Staff indicated they are trained in mandated reporting, zero tolerance, client rights and medication administration. Interviewed Clients indicated they are provided with their medications as ordered by their physicians. Staff and Clients interviews do not corroborate this allegation.

Refer to LIC 9099C for the continuation of this report.

NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20210505113455

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: JRC PLATINUM CARE HOME	FACILITY NUMBER: 198602570
	VISIT DATE: 10/14/2021

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	Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. A telephonic exit interview conducted. A copy of this report was sent electronically for signature and Appeal Rights were provided to Facility Administrator.

NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 3