198320378-5-24-2024-11-AS-EMAZ-D8QU3X-20240902151414

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320378
Report Date: 05/24/2024
Date Signed: 05/24/2024 04:35:08 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/20/2024 and conducted by Evaluator Wendy Gibbs

COMPLAINT CONTROL NUMBER: 11-AS-20240520092651

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: 68	DATE:	05/24/2024
		UNANNOUNCED	TIME BEGAN:	09:34 AM
MET WITH:	Ruby Cruz		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Staff did not ensure resident's showering needs were met

INVESTIGATION FINDINGS:

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On 05/24/24, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced 10-day complaint visit. LPA met with Administrator, Ruby Cruz, and the purpose of today’s visit was explained.

During today’s visit, LPA toured the facility, interviewed Staff S1-S5, interviewed Residents R1-R7, and received documents pertinent to the investigation. The documents include a Staff Roster, Resident Roster, Shower Log, Resident’s Physician Reports, Resident’s Pre-appraisal Evaluation, Resident Needs and Service Plan, and Staffing Notes for the past three (3) months.

The investigation revealed the following:
Allegation: Staff did not ensure resident’s showering needs were met
The allegation alleges a resident, who is a fall risk, did not receive assistance with a shower for 1 ½ months despite asking for assistance.
CONTINUED ON LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20240520092651

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: SAVANT OF SANTA MONICA	FACILITY NUMBER: 198320378
	VISIT DATE: 05/24/2024

NARRATIVE

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During record review of the shower schedule for residents who require assistance, LPA observed that residents are scheduled with an assisted shower 1 to 3 times a week. LPA reviewed four (4) Residents Physician’s Report, Needs and Service Plan, and Appraisal to see they type of assistance Residents require.
During interviews with Staff S1-S5, were asked if residents who require assistance with a shower receive assistance, five (5) out of five (5) stated residents who require assistance with a shower receive assistance. Additionally, five (5) out of five (5) stated if a resident who requires assistance with a shower requests a shower on a non-scheduled day the staff will accommodate the resident as soon as they are available, unless it is related to incontinence. During interviews with Residents R1-R7, were asked if they receive assistance with a shower, four (4) out of seven (7) stated they receive assistance with showers when scheduled and when needed or requested. Additionally, Residents R1-R7, were asked if there was a time, they not receive assistance with a shower, three (3) out of seven (7) stated they require assistance and was not provided with it. Additionally, two (2) out of the seven (7) stated they have either gotten into the shower without assistance or have taken a shower without assistance while being a fall risk.
During the course of the investigation, LPA was unable to find evidence to support the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.
During today's visit LPA did not observe or cite any deficiencies.
An exit interview was conducted with Administrator, Ruby Cruz, and a copy of this report was provided.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024

LIC9099 (FAS) - (06/04)

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