<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603477
Report Date: 11/14/2022
Date Signed: 11/14/2022 11:06:02 AM

Document Has Been Signed on 11/14/2022 11:06 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:JRC TITANIUM CARE HOME INC.FACILITY NUMBER:
198603477
ADMINISTRATOR:CANONES, RONELFACILITY TYPE:
735
ADDRESS:212 E LA VERNE AVETELEPHONE:
(909) 279-5485
CITY:POMONASTATE: CAZIP CODE:
91767
CAPACITY: 4CENSUS: 4DATE:
11/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Diana MoralesTIME COMPLETED:
10:45 AM
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
Licensing Program Analyst (LPA) Elizabeth Irra conducted an unannounced Annual visit. LPA was allowed entry into this home by Diana Morales/S-1. LPA discussed the purpose of today's visit

This is a single story home with 4 bedrooms, 2 full-bathrooms and 1 (1/2) bathroom, living room, kitchen, dinning area, office and laundry room. The home has a detached garage.

The following were observed/inspected: .
  • COVID-19 Infection Control Practices (including signs) were observed throughout the facility.
  • Signs are posted to promote hand washing, cough/sneeze etiquette, and physical distancing were observed.
  • Sufficient supply of perishable for 2 days and non-perishable foods for 7 days were observed. Plenty of drinking water supply observed.
  • PPE supplies observed.
  • Hygiene supplies observed.
  • Restrooms have hand soap, hand sanitizer and paper towels. Hand washing signs were observed inside all bathrooms.
  • Medication reviewed for (4) Clients (Client #1 through Client #4).
  • Staff responsible for direct care and supervision will wear masks.
  • Clients were be socially distanced according to local public health guidelines.

Exit interview conducted, a copy of this report and Appeal Rights were provided to Diana Morales
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Elizabeth Irra
LICENSING EVALUATOR SIGNATURE: DATE: 11/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/14/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1