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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602570
Report Date: 04/17/2025
Date Signed: 04/17/2025 02:49:56 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
04/10/2025 and conducted by Evaluator Christian Gutierrez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250410124849
FACILITY NAME:JRC PLATINUM CARE HOMEFACILITY NUMBER:
198602570
ADMINISTRATOR:CANONES, JUNELLEFACILITY TYPE:
735
ADDRESS:2929 VAMANA STREETTELEPHONE:
(909) 279-5485
CITY:POMONASTATE: CAZIP CODE:
91767
CAPACITY:4CENSUS: 4DATE:
04/17/2025
UNANNOUNCEDTIME BEGAN:
01:09 PM
MET WITH:DSP Rizalina GaetosTIME COMPLETED:
03:05 PM
ALLEGATION(S):
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Staff are not adequately trained
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christian Gutierrez conducted an unannounced complaint investigation regarding the above allegations. LPA was met by DSP worker Rizalina Gaetos and explained the purpose of the visit. Administrator Junelle Canones was notified by telephone.

The investigation consisted of the following: LPA Gutierrez requested and obtained copies of staff roster, client roster, C1’s face sheet, physicians report, hospital discharge paperwork, and restricted health care plan (RHCP). LPA conducted interviews with Administrator by telephone, and staff 1-2 (S1-S2), and client #1 (C1).

SEE 9099C
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Christian Gutierrez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2025
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 28-AS-20250410124849
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: JRC PLATINUM CARE HOME
FACILITY NUMBER: 198602570
VISIT DATE: 04/17/2025
NARRATIVE
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In regard to the allegation “Staff are not adequately trained”, it is alleged that C1 was discharged from hospital with no restricted health care plan (RHCP) in place and no staff training for RHCP. During interview with Administrator, it was disclosed that staff did not receive training till two days after C1 had returned from hospital. Administrator stated that they had previous training from the RHCP that has expired in 2020. Two (2) out of the two (2) staff confirmed that the RHCP had expired and that no training new training was given till the March 21st,2025 after C1 had been discharged from hospital. C1 stated that he/she doesn’t get oxygen anymore.

Based on record review and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Deficiencies are being cited according to California Code of Regulations, Title 22 and Health and Safety Code.

An exit interview was conducted with DSP Rizalina Gaetos. A copy of the report and appeal rights were provided.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Christian Gutierrez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20250410124849
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: JRC PLATINUM CARE HOME
FACILITY NUMBER: 198602570
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/17/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/18/2025
Section Cited
CCR
80092.2(a)
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80092.2 Restricted Health Condition Care Plan

(a) If the licensee of an ARF chooses to care for a client with a restricted health condition, as specified in Section 80092, the licensee shall develop and maintain, as part of the Needs and Services Plan, a written Restricted Health Condition Care Plan.
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Administrator submitted a new restricted health care plan to San Gabriel Regional Center and conducted an all staff training with an RN on March 21, 2025.
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Based on record review the facility did not have a current restricted health care plan for C1 and staff had not been trained until after C1 was home from hospital for two days.
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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.
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Christian Gutierrez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3