198320378-5-29-2024-11-AS-SCIS-D6DQTL-20240619122716

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320378
Report Date: 05/29/2024
Date Signed: 05/29/2024 03:25:55 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/23/2024 and conducted by Evaluator Felisa Shirley

COMPLAINT CONTROL NUMBER: 11-AS-20240523121300

FACILITY NAME:	SAVANT OF SANTA MONICA		FACILITY NUMBER:	198320378
ADMINISTRATOR:	RUBY CRUZ		FACILITY TYPE:	740
ADDRESS:	1447 17TH STREET		TELEPHONE:	(310) 829-5904
CITY:	SANTA MONICA	STATE: CA	ZIP CODE:	90404
CAPACITY:	174	CENSUS: 70	DATE:	05/29/2024
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Ruby Cruz, Executive Director		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility unlawfully evicted resident

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 5/29/24 Licensing Program Analyst (LPA) Felisa Shirley, conducted an unannounced complaint visit to the address listed above. LPA Shirley arrived at 10:15am and spoke to Administrator, Ruby Cruz and explained the purpose of the visit and was granted access to the facility.

The investigation consisted of the following:

On 5/29/24 LPA reviewed resident’s file and toured the facility. LPA requested and reviewed copies of the following records: LIC 500, Resident roster, 30day notice, ID and emergency information, face sheet, Admission Agreement, physicians report, resident appraisal, physician’s orders, resident charting notes, incident reports, memo of incident 10/22/23, and a release of personal property 5/21/24.

The investigation revealed the following:
Con'd 9099

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Felisa Shirley	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024

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 11-AS-20240523121300

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: SAVANT OF SANTA MONICA	FACILITY NUMBER: 198320378
	VISIT DATE: 05/29/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Allegation: Facility unlawfully evicted resident

It is being reported that this facility unlawfully evicted a resident. LPA Shirley reviewed the 30day notice dated 3/21/24. LPA Shirley observed that notice was issued again on 4/9/24. Notice was issued again as the first notice effective date fell on a Sunday. During file review, LPA observed resident’s charting notes in which R1 violated house rules four separate times. Per S1 resident was warned verbally to stop violating general policies of the facility. During the interview process and file review LPA learned that resident was sent to the hospital on 5/13/24. S1 stated while still in the eviction process, on 5/20/24, R1 called S2 to discharge himself from Savant of Santa Monica. S1 contacted the facility’s attorney and was told that they didn’t need to move forward as R1 discharged himself. On this same day 5/20/21, R1 asked to release their personal belongings to their friend W1. On 5/21/24, W1 came to pick up R1’s belongings and signed a release of personal property. LPA interviewed staff S-1 through S-7 (S-1 – S-7) LPA interviewed staff and ask, has this facility unlawfully evicted a resident. Of those interviewed 5 out of 7 answered no. LPA interviewed residents R-2 through R-7 (R-2 – R7). R1 is not available. LPA ask, does this facility unlawfully evict residents. Of those interviewed, 6 out of 6 answered no.

Based on information gathered, the department did not find sufficient evidence to support allegations "Facility unlawfully evicted resident. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

An exit interview was conducted and a copy of the LIC 9099 was provided to the Administrator, Ruby Cruz.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Felisa Shirley	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2