198320378-5-23-2024-11-AS-MVAO-D5RSBB-20240530134336

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320378
Report Date: 05/23/2024
Date Signed: 05/23/2024 01:27:54 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
05/16/2024 and conducted by Evaluator Perry Scott

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20240516143559

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:	05/23/2024
		UNANNOUNCED	TIME BEGAN:	10:02 AM
MET WITH:	Ruby Cruz		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff threatened a resident with eviction.

INVESTIGATION FINDINGS:

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On 05/23/24, at 10:00am, Licensing Program Analyst (LPA) Perry Scott conducted a 10-day complaint visit to the facility and was greeted by Ruby Cruz, Administrator. LPA explained the purpose of this visit is to gather information about the complaint and deliver findings for the allegation mentioned above.

The investigation consisted of the following: LPA investigated the allegation mentioned in this complaint; and conducted interviews with staff (S1-S3) and residents (R1-R3). Resident Roster, Staff Roster, ID/Emergency Information, Physicians Report, and Charting Notes for R1 were obtained from the facility.

The investigation revealed the following: Allegation #1- Staff threatened a resident with eviction.

The details of the complaint alleged that on 05/16/24, R1 and another resident were having an argument and two staff members came into the room and threatened to evict R1 because of the argument.

Report continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (707) 849-2315
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2024

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-20240516143559

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: 05/23/2024

NARRATIVE

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On 05/23/24, from 10:00am-1:00pm, LPA interviewed staff (S1-S3) and residents (R1-R3) regarding the allegation. 3 of 3 staff denied the allegation that the Staff threatened a resident with eviction. All staff (S1-S3) stated that no one has ever threatened to evict R1 with eviction. All staff (S1-S3) stated that on several occasions the staff has spoken to the resident about R1s behavior in the facility and emphasized following the house rules. But at no time has any one issued R1 an eviction notice or threatened R1 with an eviction notice. LPA interviewed R1 about the eviction notice and R1 stated that R1 had no knowledge of an eviction notice, nor did staff threaten R1 with an eviction notice. LPA interviewed R1-R3 about the allegation and 3 of 3 residents that were interviewed denied the allegation that Staff threatened a resident with eviction. All residents interviewed stated that they have not been issued or threatened with an eviction notice and are happy with the care and supervision the staff is providing them.

Based on interviews and records reviewed, there is insufficient evidence to support the allegation that the Staff threatened a resident with eviction. 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.

No deficiencies were cited.

An exit interview was conducted with Ruby Cruz, Administrator, and a hard copy of this report was provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (707) 849-2315
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2024

LIC9099 (FAS) - (06/04)

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