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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881480
Report Date: 09/16/2024
Date Signed: 09/16/2024 02:59:42 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/09/2024 and conducted by Evaluator Sara Martinez
COMPLAINT CONTROL NUMBER: 18-AS-20240909182812
FACILITY NAME:SAVANT OF RIVERSIDEFACILITY NUMBER:
331881480
ADMINISTRATOR:MOLLY BOWIEFACILITY TYPE:
740
ADDRESS:4609 ARLINGTON AVETELEPHONE:
(951) 462-1025
CITY:RIVERSIDESTATE: CAZIP CODE:
92504
CAPACITY:232CENSUS: 100DATE:
09/16/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Executive Director Molly BowieTIME COMPLETED:
03:10 PM
ALLEGATION(S):
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Staff did not release resident records upon request from resident's authorized person
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sara Martinez conducted an unannounced visit to the facility to initiate the investigation into the allegations listed above. LPA met with Executive Director Molly Bowie who was informed of the purpose for the visit. The complaint investigation consisted of interviews and records reviewed.

Regarding the allegation “Staff did not release resident records upon request from resident's authorized person”, it was reported records for Resident One (R1) was requested on 08/21/2024 and the facility has not provided the requested documents to R1’s authorized person. Staff One (S1) reported the facility received a letter requesting medical records for R1 dated 08/16/2024. S1 sent the requested documents to upper management and their legal department to review the documents before sending the requested documents to R1’s authorized representative. Records review of an email reveals S1 sent R1’s requested documents to upper management on 08/21/2024. During today’s visit, LPA Martinez confirmed with R1’s authorized representative they have not received the requested documents.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Sara Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2024
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 18-AS-20240909182812
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: SAVANT OF RIVERSIDE
FACILITY NUMBER: 331881480
VISIT DATE: 09/16/2024
NARRATIVE
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Based on LPA’s observations, interviews conducted, and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099 D.

An exit interview was conducted and a copy of this report, LIC 9099-D, LIC 811- Confidential Names, and appeal rights was provided to Executive Director Bowie.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Sara Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20240909182812
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: SAVANT OF RIVERSIDE
FACILITY NUMBER: 331881480
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/27/2024
Section Cited
CCR
87468.2(a)(19)
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87468.2 Additional Personal Rights of Residents...(a) In addition to the rights listed in Section 87468.1... residents in privately operated residential care facilities...shall have(19)... prompt access to review all of their records...provided within two business days... This requirement is not met as evidenced by:
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Licensee will ensure requested documents will be sent to R1's authorized responsible party before the plan of correction date 09/27/2024.
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Based on interview and records review, the Licensee did not comply with the section cited above by not providing R1 records to R1 representative as required which poses a potential health, safety and personal rights risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Sara Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3