198320378-4-23-2025-11-AS-SCIS-DGP342-20250514175424

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320378
Report Date: 04/23/2025
Date Signed: 04/23/2025 04:09:57 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
04/17/2025 and conducted by Evaluator Felisa Shirley

COMPLAINT CONTROL NUMBER: 11-AS-20250417162558

FACILITY NAME:	SAVANT OF SANTA MONICA		FACILITY NUMBER:	198320378
ADMINISTRATOR:	NATHANIEL VENZON		FACILITY TYPE:	740
ADDRESS:	1447 17TH STREET		TELEPHONE:	(310) 829-5904
CITY:	SANTA MONICA	STATE: CA	ZIP CODE:	90404
CAPACITY:	174	CENSUS: 93	DATE:	04/23/2025
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Brooke LoMotte, Wellness Director		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Staff did not dispense medication(s) to resident as prescribed.
Staff did not assist resident with incontinence care needs in a timely manner.

INVESTIGATION FINDINGS:

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On 4/23/25 at 10:30 am, Licensing Program Analyst (LPA) Felisa Shirley, conducted an unannounced complaint visit to the address listed above. LPA Shirley arrived and spoke to the Wellness Director, Brooke LaMotte and the purpose of the visit was discussed. LPA was granted access to the facility.

The investigation consisted of the following:

On 4/23/25 LPA requested and reviewed copies of the following records: Staff Roster, Resident Roster, Medication Technician Schedule, Medication Training certificates, and incontinence sheets. LPA Felisa Shirley toured the facility and interviewed Staff #1 – 9 and Residents #1 – 9.

Con'd on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025

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 3

Control Number 11-AS-20250417162558

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: 04/23/2025

NARRATIVE

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The investigation revealed the following:

Allegation: Staff did not dispense medications to resident as prescribed.

On 4/23/25, LPA Shirley observed medication training certificates for all three staff. LPA observed the Medication Technician schedule and saw that there are 2 medication staff in the morning, 2 in the evening and 1 on the Nocturnal shift (NOC). The Wellness Director assist the team as needed. LPA Shirley monitored S5 dispense medications through the QuikMar system to five residents during lunch. S5 matched resident’s picture and name to resident, and dispensed medication according to time of day and dose prescribed by doctor. Once the medication was dispensed the picture turns grey to indicate that medication was administered. LPA Shirley confirmed that MAR matched physical medication. Per interview with Wellness director, there were there were an additional six Medication Technicians hired with a start day of May 1^st.

LPA Shirley interviewed staff-1 thru staff-9 (S-1 thru S-9). LPA asked, does staff dispense medications to residents as prescribed. Of those interviewed, 9 out of 9 staff answered yes. LPA interviewed Resident-1 thru Resident-9 (R-1 thru R-9). LPA asked, does staff dispense your medications on time as prescribed. Of those interviewed, 6 out of 9 answered yes, 2 answered, no and 1 resident administered their own medications.

Based on records review, interviews and observations, LPA did not find sufficient evidence to support the above allegation. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is Unsubstantiated.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20250417162558

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: 04/23/2025

NARRATIVE

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Allegation: Staff did not assist resident with incontinence care needs in a timely manner.

On 4/23/25, LPA Shirley Reviewed the incontinence schedule for 2 residents and observed that residents are being changed every 2 hours. Per interview with 5 staff members residents are changed every 2 hours or when called. Per interview with Wellness Director, the facility is short staffed and there were eight additional caregivers hired with an estimated start date of May 1^st.

LPA Shirley interviewed staff-1 thru staff-9 (S-1 thru S-9). LPA asked, does staff assist residents with incontinence care needs in a timely manner. Of those interviewed, 9 out of 9 staff answered yes. LPA interviewed Resident-1 thru Resident-9 (R-1 thru R-9). LPA asked, does staff assist you with your incontinence needs in a timely manner. Of those interviewed, 5 out of 9 answered yes, and 4 stated that they were independent.

Regarding the allegations, the Department found no evidence to support the allegation mentioned above. 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, as a result, the allegation is Unsubstantiated.

No deficiencies were cited for this allegation.

An exit interview was conducted and a copy of this report was provided to the Wellness Director, Brooke LaMotte.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025

LIC9099 (FAS) - (06/04)

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