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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603477
Report Date: 06/16/2022
Date Signed: 06/16/2022 03:45:17 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
06/10/2022 and conducted by Evaluator Elizabeth Irra
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220610153012
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: 3DATE:
06/16/2022
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:S-1TIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff did not prevent client from causing self harm while in care.
Staff did not treat client with dignity and respect.
Staff inappropriately spoke to client.

INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Elizabeth Irra conducted the initial 10-day complaint visit. LPA discussed the purpose of today's visit with S-1.

During this visit, LPA interviewed Staff #1 through Staff #3 (S-1 through S-3) and Client #1 through Client #3 (C-1 through C-3). LPA reviewed C-1's file and obtained relevant documentation.

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: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022
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-20220610153012
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: 06/16/2022
NARRATIVE
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Allegation: Staff did not prevent client from causing self harm while in care.
During this investigation, LPA interviewed Staff #1 through Staff #3 (S-1 through S-3) and Client #1 through Client #3 (C-1 through C-3). Staff interviews revealed that staff asked C-1 if C-1 was going to attend C-1’s day program on 06/09/22 (as the day program transportation had arrived) as C-1 woke up, took medications, had breakfast and returned to C-1’s bedroom. Per staff interviews, C-1 did not inform staff that C-1 was experiencing pain on the right thigh and did not ask for pain medication. Per staff interviews, staff do not refuse to give clients their medication. Per staff interviews, all medication disbursements are documented in a Medication Administration Record (MAR) which also includes pain medication. Staff interviews revealed that C-1 got upset when C-1 was asked if C-1 was going to attend day program. Staff interviews indicated that C-1 began to punch the walls in C-1’s bedroom quickly, threw coffee at the bedroom closet and was being rude (cursing) at staff. Staff initially attempted to redirect C-1 verbally and C-1 was getting more agitated and was talking to C-1’s self. Per Staff interviews, C-1 eventually followed staff redirection, got dressed and ready and left to the day program. Per Staff interviews, C-1 has a history of admitting self into a psychiatric hold (which C-1 proceeded to do on 06/09/22 while C-1 was at the day program). Client interviews revealed that they were inside their room when this incident occurred. Client interviews revealed that they have not witness anyone self-harming themselves in this home. Staff and client interviews do not corroborate this allegation.

Allegation: Staff did not treat client with dignity and respect.
During this investigation, LPA interviewed Staff #1 through Staff #3 (S-1 through S-3) and Client #1 through Client #3 (C-1 through C-3). Staff interviews revealed that all clients are treated with dignity and respect. Staff interviews revealed that on 06/09/22, C-1 was being rude and cursing at the staff. Interviewed staff indicated staff did not pull C-1’s comforter off him. Interviewed staff indicated staff are trained in client rights, mandated reporting, zero tolerance and crisis prevention intervention (CPI). Interviewed staff also indicated they have not witnessed nor received any complaints about staff not treating clients with dignity and respect. (2) out of the (3) interviewed clients indicated that staff always treat clients with dignity and respect. (2) out of the (3) interviewed clients indicated they have not witnessed staff mistreating clients. Staff and client interviews 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: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20220610153012
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: 06/16/2022
NARRATIVE
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Allegation: Staff inappropriately spoke to client.
During this investigation, LPA interviewed Staff #1 through Staff #3 (S-1 through S-3) and Client #1 through Client #3 (C-1 through C-3). Staff interviews revealed that staff do not speak to clients inappropriately. Interviewed staff indicated they did not tell C-1 “get your ass out of here”. (2) out of (3) clients indicated that staff do not speak to clients inappropriately. Staff and clients interviews do not corroborate this allegation.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated

Exit interview conducted, Appeals Rights and a copy of this report was provided to S-1.
NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3