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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 335530032
Report Date: 03/18/2025
Date Signed: 05/09/2025 11:32:20 AM

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
03/13/2025 and conducted by Evaluator Javier Prieto
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20250313125511
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:
03/18/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Audrey Munoz, Wellness Supervisor TIME COMPLETED:
01:20 PM
ALLEGATION(S):
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Staff did not ensure the resident had a shower bar in bathroom resulting in falls

Due to lack of supervision, resident was left on floor for an extended period of time
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Javier Prieto arrived at the facility to conduct a complaint investigation regarding the allegations referenced above. LPA Prieto met with Wellness Supervisor Munoz and provided an explanation of the elements of the complaint.

Allegation #1: LPA Prieto conducted a tour of Resident #1's (R1) room and observed that the bathroom is equipped with a grab bar as required. LPA was informed by the wellness supervisor that the facility ordered a new additional grab bar for R1’s shower. There is no evidence to corroborate that R1 had falls due to no grab bar in the bathroom.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2025
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-20250313125511
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: 03/18/2025
NARRATIVE
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Allegation #2: It was alleged that R1 fell in the shower and remained on the shower for an extended period of time. LPA interview with R1 stated she fell in the shower and immediately reported to Wellness Supervisor (S1), who made an assessment and monitored R1 for any bruising or pain the same day. R1 did not indicate that she waited for an extended period of time. Wellness Director (S2), documented the fall and the followed up with R1 for the next 3 weeks as indicated on R1's Wellness notes that where obtained during the investigation.

S1 also provided LPA with R1's activity report related to her call pendant. Records show that R1 did not press her call pendent on the alleged date of 02/18/2025. During interview with R1, she did not express that the call button was pressed nor that he waited for an extended period of time for assistance.

Based on the information gathered, there is insufficient evidence to support the claims made in this complaint. Therefore, the allegations are deemed unsubstantiated at this time. This report was signed by LPA Prieto and Executive Director Marc Pacia, and a copy was provided to the facility.

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

DATE: 03/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2