198603477-1-19-2023-28-AS-RORN-CSBUSX-20230530155103

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603477
Report Date: 01/19/2023
Date Signed: 01/19/2023 03:45:19 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
01/13/2023 and conducted by Evaluator Angelica Rea

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230113161409

FACILITY NAME:	JRC TITANIUM CARE HOME INC.		FACILITY NUMBER:	198603477
ADMINISTRATOR:	CANONES, RONEL		FACILITY TYPE:	735
ADDRESS:	212 E LA VERNE AVE		TELEPHONE:	(909) 279-5485
CITY:	POMONA	STATE: CA	ZIP CODE:	91767
CAPACITY:	4	CENSUS: 3	DATE:	01/19/2023
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Ronel Canones		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff caused an injury to resident in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angelica Rea conducted an unannounced visit in response to the above allegation.

LPA met with Staff, Janeane Snedeker who allowed entry into the facility and called Administrator, Ronel Canones who arrived at the facility a short time later.

Regarding the allegation that staff caused an injury to resident in care, the investigation consisted of interviews with Administrator, Staff #1, Resident #1 - Resident #3, and review of Resident #4's file. LPA obtained copies of specific documents from resident #4's file. Resident #4's IPP report indicates that Resident #1 has a history of self injurious behavior(s).

The investigation revealed that Resident #4 lived at the facility from 10/11/23 - 1/10/23. Staff interviewed stated that Resident #4 went on a home visit on 12/23/22, and returned on 12/26/22.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Angelica Rea
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2023

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 28-AS-20230113161409

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 TITANIUM CARE HOME INC.	FACILITY NUMBER: 198603477
	VISIT DATE: 01/19/2023

NARRATIVE

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Upon returning to the facility on 12/26/22, staff stated that resident #4's family member stated that resident #4 had a bruise on her right arm. Resident #4's family member asked staff how the bruise happened. Staff stated that they performed a body check prior to resident #4 leaving the facility on 12/23/22, and did not observe any bruises. Staff stated that resident #4 did not answer consistently, when asked about how she obtained the bruise. Staff stated that resident #4 stated several different names. Staff interviewed denied that staff harm residents or cause any injuries to resident(s) in care. Residents interviewed were unable to corroborate the allegation. They stated that they have not observed staff harm any residents in care. Resident #4 was relocated on 1/10/23, and was not interviewed.

Based on LPA's observations and interviews, investigation revealed: Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

No Deficiencies cited under California Code of Regulations Title 22. Exit interview conducted, and a copy of report was provided to Administrator, Ronel Canones.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Angelica Rea
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2023

LIC9099 (FAS) - (06/04)

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