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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603597
Report Date: 05/16/2025
Date Signed: 05/16/2025 02:59:49 PM

Substantiated


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
03/27/2025 and conducted by Evaluator Nicol Wesley
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250327140118
FACILITY NAME:SAVANT OF ALHAMBRAFACILITY NUMBER:
198603597
ADMINISTRATOR:MADELEINE SIEVERTFACILITY TYPE:
740
ADDRESS:1 E COMMONWEALTH AVETELEPHONE:
(626) 289-3871
CITY:ALHAMBRASTATE: CAZIP CODE:
91801
CAPACITY:176CENSUS: 152DATE:
05/16/2025
UNANNOUNCEDTIME BEGAN:
11:28 AM
MET WITH:Madeleine SievertTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not meet resident's basic needs due to insufficient staffing.
Staff do not keep resident's room clean & sanitary.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Nicol Wesley conducted a subsequent visit at the facility and met with Administrator Madeleine Sievert to discuss the purpose of the visit.

Investigation consisted of: staff roster, resident roster, incontinence records, house keeping records, interviewed staff, interviewed residents, walked around and toured the facility.

Investigation revealed:
Regarding allegation: Staff do not meet resident's basic needs due to insufficient staffing, and Staff do not keep resident's room clean & sanitary. on 04/03/25, LPA Wesley and the Administrator Madeleine Sievert toured the facility and found that several rooms were not cleaned. LPA asked the administrator how many staff were on duty and she provided me with the names 2 med technicians, 5 caregivers, 2 housekeepers, and 1 laundry attendant on duty. LPA visited random clients rooms and found that the trash was not
Continued on LIC 9099C
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Nicol Wesley
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2025
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-20250327140118
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: SAVANT OF ALHAMBRA
FACILITY NUMBER: 198603597
VISIT DATE: 05/16/2025
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
26
27
28
29
30
31
32
emptied, restroom has not been cleaned, and their linen was not changed, as well as a resident was in a soiled undergarment. Pictures were taken. LPA Wesley interviewed 2 caregivers and they indicated that they are short staff and are in need of help, and interviewed 1 housekeeper and They indicated that they are okay. There was some random people visiting their loved ones and they indicated that they come and clean the rooms, sweep and take their trash away. LPA interviewed 12 residents and they said there rooms are supposed to be cleaned once a week, and the trash emptied daily, but they do not come the 3 residents didn't want to comment. The rooms were not clean and sanitary. On 04/03/25, LPA Wesley was at the facility from 11:20am-4:30pm. Pictures were taken.

Based on LPA observations and interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be Substantiated.

California Code of Regulations,Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D. Appeal rights were given. A copy of the LIC 9099/LIC 9099C/LIC 9099D was given during the exit interview.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Nicol Wesley
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20250327140118
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: SAVANT OF ALHAMBRA
FACILITY NUMBER: 198603597
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/16/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
05/30/2025
Section Cited
CCR
87303(a)
1
2
3
4
5
6
7
Maintenance and Operation
The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.

1
2
3
4
5
6
7
The administrator shall ensure all the residents rooms are clean. Create an inservice training "Maintenace and Operations" for all staff and go what needs to be cleaned. HIre more staff if necessary.

8
9
10
11
12
13
14
This evidence was not met as required
LPA and the Administrator observed several rooms that were not cleaned by staff, which includes emptying the trash, cleaing the bathrooms, and changing the linen.
8
9
10
11
12
13
14
Submit the in service training sign in sheet to LPA Wesley 323 980 4912 by the POC date 05/30/25.
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Nicol Wesley
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3