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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 335530032
Report Date: 03/06/2025
Date Signed: 03/06/2025 01:25:01 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
07/08/2024 and conducted by Evaluator Javier Prieto
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240708163311
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: 159DATE:
03/06/2025
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Marc Pacia, Executive DirectorTIME COMPLETED:
01:25 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff not assisting resident on transferring in and out of a wheelchair

Staff not providing three meals to a resident as required

Staff left resident in a soiled diaper for hours

Staff not safeguarding resident personal belongings
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Javier Prieto arrived at the facility to conclude a complaint investigation regarding the above allegations. LPA Prieto met with Executive Director Pacia and explained the elements of the complaint.

Allegation #1: LPA interviewed resident #1 (R1), who stated that she does not require assistance from staff for transferring in her wheelchair as she is non-ambulatory and receives services in her room such as bathing, dressing, toileting, and meal delivery. The Resident Service Plan, provided to LPA by Wellness Director (S1), reveals that services performed by staff in R1's room include bathing, dressing, toileting, meal delivery, and medication management. These services do not necessitate transferring R1 in and out of a wheelchair.

Allegation #2: In an interview with R1, she confirmed that she receives all three of her meals in her room. The Resident Service Plan indicates that R1 is receiving tray services for all meals from the dining staff, delivered to her room.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025
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 2
Control Number 56-AS-20240708163311
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: 03/06/2025
NARRATIVE
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Allegation #3: R1 stated that her toileting needs are routinely addressed by staff, and any additional unscheduled services are also taken care of. The Resident Service Plan reveals that R1 requires full assistance with toileting, including frequent or unscheduled incontinence care.

Allegation #4: During the interview, R1 did not report any personal belongings or money missing or taken. LPA observed that R1 has her wallet and bags on her bed, out of reach of staff and other residents. There is no evidence to support the allegation that staff are not safeguarding R1's personal belongings.

Interviews with residents 1 through 10 reveal that their needs are being adequately cared for while residing at the facility.

Based on the information obtained, there is not enough evidence to support the allegations of staff not assisting residents in transferring in and out of a wheelchair, not providing three meals to a resident as required, leaving a resident in a soiled diaper for hours, or not safeguarding residents' personal belongings. Therefore, the allegations are deemed UNSUBSTANTIATED at this time. This report was signed by LPA Prieto and Executive Director Pacia, and a copy was left with the facility.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2