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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 335530032
Report Date: 10/24/2024
Date Signed: 10/24/2024 01:45:05 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
03/25/2024 and conducted by Evaluator Javier Prieto
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240325083715
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: 148DATE:
10/24/2024
UNANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH: Marc Pacia, Executive DirectorTIME COMPLETED:
01:50 PM
ALLEGATION(S):
1
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9
Staff moved resident to another room without her consent
Staff spoke inappropriately to resident
INVESTIGATION FINDINGS:
1
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13
Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to conduct a complaint investigation regarding the above allegations. LPA Prieto met with Executive Director Marc Pacia and explained the elements of the compliant.

Allegation #1, staff #1 (S1) interview states that resident #1 (R1) in question was moved per family request. Request was asked from R1's family as to S1 due to the location being closer to dining area, as mentioned to R1's family. S1 states R1 was made aware of move by R1's family. R1 states to S1 that R1 cannot transfer to the dining area easy due to her diagnosis and needs and services plan. Needs and service plan was obtained and reveal the R1 is able to transfer independently. R1 no longer resides at the facility to interview regarding this allegation.

Allegation #2, it is alleged that R1 stated that staff spoke to R1 inappropriately relating to R1's stay. Staff stated that R1 was made aware that if R1 is not happy at the facility, another facility would be found for her to stay. R1 was not available to interview relating to this allegation.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024
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-20240325083715
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: 10/24/2024
NARRATIVE
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Needs and services plan for R1 was obtained and found that R1 is independent with most of her Activities of Daily Living (ADL). Previous interview with R1, with LPA, revealed that R1 was satisfied with the care and stay at the facility and all request for change and modifications were accommodated by Executive Director (S1) at the time.

Based on the information obtained there is not enough evidence that staff spoke inappropriately to resident and Staff moved resident to another room without her consent. Therefore, the allegations are deemed UNSUBSTANTIATED at this time. This report was signed by LPA Prieto and Executive Director Pacia
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2