198603477-10-19-2023-28-AS-TVAO-CXBML7-20231106084150

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603477
Report Date: 10/19/2023
Date Signed: 10/19/2023 01:54:43 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
06/02/2023 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230602135820

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: 4	DATE:	10/19/2023
		UNANNOUNCED	TIME BEGAN:	12:52 PM
MET WITH:	Amber Torres, Staff		TIME COMPLETED:	01:40 PM

ALLEGATION(S):

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Staff caused injuries to client.
Staff physically abused client while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent visit regarding the allegations listed above. LPA met with Staff Amber Torres and explained the purpose of the visit.

The investigation consisted of the following:
On 6/5/23, LPA Chan toured the facility and did not observe any health and safety concerns. Food supplies were sufficient. Knives and cleaning products were locked in cabinets. LPA gathered documents pertaining to Client #1 and requested documents for Staff #1 to be emailed. The allegation, staff physically abused client while in care, was further investigated by the department’s Investigation Branch (IB) Investigator Heidy Bendana.

(Continue on LIC9099C)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

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-20230602135820

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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
	VISIT DATE: 10/19/2023

NARRATIVE

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The investigation revealed the following:

Allegations – Staff physically abused client while in care and Staff caused injuries to client. It was alleged that Staff #1 (S-1) physically assaulted Client #1 (C-1) and caused injuries due to a physical altercation. IB Investigator Bendana interviewed the Administrator, Staff, Clients, and family members regarding this allegation. Per interview with S-1, C-1 misinterpreted a statement made by S-1 and resulted in C-1 physically attacking staff. During the assault, S-1 ran into the office and managed to contact 911. The dispatcher instructed staff to find a way to get away from C-1. As C-1 continued to attack S-1, staff bit C-1’s hand in self- defense to create time and space to run away from client. Per hospital medical records, x-ray of the C-1’s hand showed that the bones and soft tissues appeared normal. S-1 sustained multiple injuries to the upper body. The police responded to the incident, but there was no report available for review.

According to interviews and documentation, C-1 has a history of aggressive behavior and had previously assaulted other staff and a resident. In addition, C-1 was removed from another facility due to aggressive behavior. Based on information gathered, it is determined that S-1 did not physically assault C-1 and therefore, the scratches and bite mark on C-1 was due to self-defense.

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.

An exit interview was conducted with Ms. Torres. A copy of this report along with the appeal rights were provided.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

LIC9099 (FAS) - (06/04)

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