331881480-7-26-2025-18-AS-KBUY-DK42LZ-20250730173022

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881480
Report Date: 07/26/2025
Date Signed: 07/26/2025 10:01:23 AM

Unsubstantiated

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
10/17/2024 and conducted by Evaluator Emily Peraldi

COMPLAINT CONTROL NUMBER: 18-AS-20241017140824

FACILITY NAME:	SAVANT OF RIVERSIDE		FACILITY NUMBER:	331881480
ADMINISTRATOR:	MOLLY BOWIE		FACILITY TYPE:	740
ADDRESS:	4609 ARLINGTON AVE		TELEPHONE:	(951) 462-1025
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92504
CAPACITY:	232	CENSUS: 100	DATE:	07/26/2025
		UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Edgar Mendez		TIME COMPLETED:	10:05 AM

ALLEGATION(S):

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Resident was hit over the head by another resident due to lack of supervision.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Emily Peraldi conducted a subsequent complaint visit to deliver final findings for the above allegation. During today’s visit, LPA Peraldi met with the Culinary Manager Edgar Mendez and explained the reason for the visit.

On 10/17/2024, the Riverside Adult and Senior Care Regional Office (RO) received a complaint regarding an allegation of lack of supervision. The complaint alleged that Resident #2 (R2) hit Resident #1 (R1) over the head.

On 10/23/2024, from 8:15am to 12:15pm, Licensing Program Analyst (LPA) Janette Romero arrived unannounced to investigate the allegation listed above. LPA Romero met with the Administrator, Molly Bowie, who was informed of the purpose of the visit. During the visit, the LPA toured the facility, conducted interviews, and obtained copies of pertinent documentation. Continued on LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Emily Peraldi
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2025

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 18-AS-20241017140824

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: 07/26/2025

NARRATIVE

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The LPA attempted to interview Resident #2 (R2) who refused to be interviewed or speak with the LPA. The Administrator was advised that further investigation was needed prior to issuing findings.

A review of R1’s physician report, dated 01/31/2020, listed the primary diagnosis as diabetes type 2, and secondary diagnosis listed as HTN, bipolar I, atrial flutter, and sinus node dysfunction. R1 was able to leave the facility unassisted. No cognitive impairment was noted. R1’s resident assessment, dated 08/21/2024, listed R1 as independent for bathing, dressing, grooming, toileting, transfer and mobility. R1 required use of cane, walker, wheelchair, diabetic diet, and assistance with glucose monitoring. Chronic pain and mental health services were also noted. No cognitive impairment was noted. Behaviors listed as moderate with daily interventions needed due to disruptive, aggressive, or socially inappropriate behavior. Current depression, anxiety, mood disorder. Requires medication assistance, injections 3 times per day, has a psychiatrist and a case manager.

A review of R2’s physician report, dated 02/06/2024, listed the primary diagnosis as Schizophrenia, unspecified. No cognitive impairment was noted. R2 was not able to leave the facility unassisted. R2’s resident assessment, dated 07/10/2024, listed R2 as non-ambulatory, having dementia, behavior impairment, confused, agitated, uncooperative and resistant to care assistance. R2 is conserved by the public guardian.

According to the Administrator, the medtech reported on 10/02/2024, 2:00am, they heard loud screaming from R1 and R2 in the activity room, came to check, and separate them when R2 hit R1 on the back of head. Riverside Police Department were called and escorted R2 back to their room. There was no visible injury, but R1 complained of pain, and 911 was called. R1 returned to the facility the same day. The Administrator does not recall if R1 had an injury, and does not know the discharge diagnosis as R1 refused to give the facility any paperwork from the hospital. The Administrator stated on 10/02/2024 the facility census was 105 and the overnight (NOC) shift had two team members working. Both the residents’ physicians were notified. R2’s public guardian was also informed of the incident.

Continued on LIC 9099-C.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Emily Peraldi
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2025

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20241017140824

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: 07/26/2025

NARRATIVE

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The review of Unusual Incident/Injury Reports (SIRs) and facility notes related to R1 revealed on 10/17/2024, R1 called 911 due to experiencing stroke-like symptoms. R1 had a droopy eye, stated they did not feel like themselves, and complained of pain in their temple. The ambulance transported R1 to the hospital. R1 returned to the facility on 10/22/2024 with a new order of Pradaxa and to follow up with their primary care physician. R1 did not provide any paperwork from the hospital to the facility. On 10/23/2024, R1 reported feeling dizzy and called 911, R1 was taken to emergency room and returned to the facility the same day. R1 did not provide any discharge paperwork to the facility.

During the course of the investigation, the Department was not able to obtain an interview with R1. Per the Administrator, R1 moved out of the facility on 11/11/2024 and there is no contact information for R1.

The information obtained during the Department’s investigation did not sufficiently support the allegation. While R1 was hit on the head during an altercation with R2, the investigation did not provide sufficient evidence to substantiate neglect/lack of supervision by facility staff. Therefore, the allegation is deemed Unsubstantiated at this time.

Exit interview conducted, copy of this report issued.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Emily Peraldi
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2025

LIC9099 (FAS) - (06/04)

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