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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 335530032
Report Date: 04/08/2024
Date Signed: 04/08/2024 02:51:03 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, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/04/2024 and conducted by Evaluator Javier Prieto
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240404113629
FACILITY NAME:SAVANT OF JURUPA VALLEYFACILITY NUMBER:
335530032
ADMINISTRATOR:PATRICK L. MCADOO-MORTONFACILITY TYPE:
740
ADDRESS:5881 EL PALOMINO DRIVETELEPHONE:
(951) 683-3333
CITY:RIVERSIDESTATE: CAZIP CODE:
92509
CAPACITY:197CENSUS: 156DATE:
04/08/2024
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Savanna Castro, Assistant Business Office Manager TIME COMPLETED:
02:55 PM
ALLEGATION(S):
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Resident was left soiled for an extended period while in care.
Staff are not meeting resident's hygiene needs.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Javier Prieto arrived to the facility conduct a complaint investigation regarding the above allegations. LPA Prieto met with Assistant Business Office Manager Savanna Castro and explained the elements of the complaint. LPA toured the facility, interviewed resident and gathered pertinent documentation.

Regarding the allegation that resident was left soiled for an extended period while in care; LPA Prieto obtained resident #1 (R1) service plan which states that R1 is not on an incontinece place, but a bathing plan, with a one person assist, once per week. LPA Prieto obtained shower schedule that shows R1 is bathed once a week. LPA Prieto interviewed R1 who stated that the service plan indicates assistance with toileting 3 times
****continued on 9099C***
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2024
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 2
Control Number 56-AS-20240404113629
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: SAVANT OF JURUPA VALLEY
FACILITY NUMBER: 335530032
VISIT DATE: 04/08/2024
NARRATIVE
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per day. R1 stated that he ask for assistance, but still has difficulty and would rather use an adult diaper, which is R1 is required to provide and not part of R1's care plan. R1's service plan indicates that there is no special care needs and R1 can self manage. Facility staff has assisted R1 in obtaining incontinence care product in the future.

Regarding the allegation that staff are not meeting resident's hygiene needs; R1's service plan states that a minimum assist with dressing. moderate assist with grooming, no special care needs. R1 has a service plan for laundry service once a week. R1 is required provide R1's own care products.

Based on the information obtained there is not enough evidence that resident was left soiled for an extended period while in care and staff are not meeting resident's hygiene needs. Therefore, the allegations are deemed UNSUBSTANTIATED at this time. This report was signed by LPA Prieto and Ms Castro and a copy was left with the facility.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2