198320378-8-13-2024-11-AS-EMAZ-D8QU5S-20240902151713

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320378
Report Date: 08/13/2024
Date Signed: 08/13/2024 04:03:45 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
07/25/2024 and conducted by Evaluator Wendy Gibbs

COMPLAINT CONTROL NUMBER: 11-AS-20240725205758

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:	DATE:	08/13/2024
		UNANNOUNCED	TIME BEGAN:	01:11 PM
MET WITH:	Narine Mertkhanan		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are stealing clients' personal food items
Staff do not provide adequate amount of food.
Staff pulled resident's hair.
Staff inappropriately touched resident.

INVESTIGATION FINDINGS:

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

On 08/13/24, Licensing Program Analyst (LPA), Wendy Gibbs conducted and unannounced subsequent visit to the facility listed above to deliver findings for the complaint indicated above. LPA met with Administrator, Narine Mertkhanan, and the purpose of today’s visit was explained.
During a previous visit conducted on 07/31/24, Licensing Program Analysts (LPAs), Wendy Gibbs and Deborah Lee, conducted an unannounced 10-day complaint visit to the facility listed above. LPAs met with Business Office Manager, Ashley Fernandez and the purpose of that visit was explained. We were later joined by Administrator, Narine Mertkhanan.
During the visit, LPAs toured the facility, interviewed Staff S1-S8, interviewed Residents R2-R9, and received documents pertinent to the investigation. The following documents were received Staff Roster, Resident Roster, Weekly Menu’s, Nutritionist Menu Review, Alternative Meal Menu Selections, Snack Menu, Theft/Loss Policy, residents Admission Agreement, resident Safeguard of Valuables/Property, Staff Mandated Reporting Training, and Staff End of Shift book.
The investigation revealed the following:

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: 08/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024

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 6

Control Number 11-AS-20240725205758

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: 08/13/2024

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: Staff did not safeguard residents’ personal property
The complaint allegation alleges staff have been stealing residents personal belonging such as perfume.
During record review, LPA reviewed the facility’s Theft/Loss Policy, that indicates that the resident or responsible party does have the option to refuse or disclose personal items being brought into the facility to be inventoried. LPA reviewed Resident’s R1, R2, R5, and R7 Client/Resident Personal Property and Valuables (LIC621) observed two of the residents opted not to have their personal items inventoried, and two (2) of the residents listed minimal personal belongings on the LIC621. LPA reviewed R1s LIC621 and did not observe perfume listed.
During interviews with Resident’s R2-R9, were asked if they have had any personal items go missing, eight (8) out of eight (8) stated they have had no item go missing or that were stolen.
During interviews with Staff S1, S2, S4-S8, were asked how staff help residents safeguard their personal belongings, seven (7) out of seven (7), stated they remind residents to lock their door when they leave their room. Additionally, two (2) of the seven (7) stated they encourage residents to keep their valuables in their room, so they do not get lost in the facility. During interviews with Staff S2, S4-S8, were asked if there were any reported missing or stolen items in the past two (2) months, four (4) out of six (6) stated two (2) residents have reported missing items. One resident reported a missing phone and money which were found in the resident’s room with staff assistance, and the other resident is R1, who according to staff, gives their belongings and money to other residents.

(2) Continued On LIC9099-C

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024

LIC9099 (FAS) - (06/04)

Page: 6 of 6

Control Number 11-AS-20240725205758

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: 08/13/2024

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

During an interview with S2, they stated R1 was upset that a bottle of perfume was stolen by another resident. S2 and the former administrator spoke with R1 and was informed that R1 gave R2 a bottle of perfume, R2 did not like the perfume so R2 gave it away to someone else. LPAs asked R2 about the incident with a bottle of perfume R1 had given them and R2 stated “I sprayed it on myself, and I did not like it.”
Additionally, two (2) out of six (6) stated they have witnessed R1 giving belongings away and have told R1, they do not have to give their belongings or money to other residents in the facility.
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.

Allegation: Staff do not provide adequate amount of food

The complaint allegation alleges that the food received is minimal.
During the facility visit, LPA’s observed kitchen staff making the plates for residents’ lunch. LPA’s observed ample portions of food on each plate. LPAs observed staff using measuring ladle for portioning the sides.
During record review, LPAs received and reviewed a copy of the weekly menus and the Alternative Option Menu available if residents do not want what is on the menu.
During interviews with Resident’s R2-R9, were asked if they are provided with enough food, seven (7) out of eight (8) stated they are provided with enough food to eat. Additionally, one resident stated they sometimes get hungry after dinner,

(3) Continued on LIC9099-C

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024

LIC9099 (FAS) - (06/04)

Page: 5 of 6

Control Number 11-AS-20240725205758

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: 08/13/2024

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

and they don’t want to go downstairs to get a snack.
During interviews with staff S2-S8 were asked if residents were provided with enough food throughout the day, seven (7) out of seven (7) stated yes residents are provided with 3 meals a day and snacks are always available. Additionally, during interviews with Staff S2-S8, were asked if there have been any complaints about the portion of food provided, six (6) out of seven (7) stated they have not heard any complaints. One staff stated there were a few complaints over a month ago that the portions were small, but no new current complaints.
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.

Allegation: Staff pulled resident’s hair

The complaint allegation alleges a staff pulled residents hair out.
During record review, LPAs reviewed and received staffs signed Mandated Reporting that states if they observe or suspect abuse occurring, they will report it. Additionally, LPAs received and reviewed a copy of the facility’s Employee Handbook stating, on pages 71-72, employees responsibility to report any incident of resident abuse, or suspected resident abuse.
During interviews with Residents R2- R9, were asked if their hair has been pulled by staff or have been handled in a rough manner, eight (8) out of eight (8) stated staff has not pulled their hair nor have they been handled in a rough manner.

(4) Continued on LIC9099-C

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 6

Control Number 11-AS-20240725205758

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: 08/13/2024

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

During interviews with Staff S2, S4-S8, were asked if they have observed staff or if they have pulled a resident’s hair or have handled a resident in a rough manner, six (6) out of six (6) stated they have not pulled a resident’s hair or handled a resident in a rough manner, nor have they observed, or heard of that occurring.
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.

Allegation: Staff inappropriately touched resident

The complaint allegation alleges a staff grabbed a resident’s butt.
During record review, LPAs reviewed and received staffs signed Mandated Reporting that states if they observe or suspect abuse occurring, they will report it. Additionally, LPAs received and reviewed a copy of the facility’s Employee Handbook stating, on page 71-72, employees responsibility to report any incident of resident abuse, or suspected resident abuse.
During interviews with Residents R2- R9, were asked if staff have touched them inappropriately, eight (8) out of eight (8) stated staff have not touched them inappropriately at any time.
During interviews with Staff S2, S4-S8, were asked if they have observed staff, have heard of staff, or if they have touched a resident inappropriately, six (6) out of six (6) stated they have not seen or heard of a staff touching a resident inappropriately and if they did, they would report it to the Administrator immediately. Additionally, six (6) out of six (6) stated they have not touched a resident inappropriately.
(5) Continued on LIC9099-C

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 6

Control Number 11-AS-20240725205758

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: 08/13/2024

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

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, Narine Mertkhanan, and a copy of this report was provided.

(6)

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 6