198603172-9-19-2024-28-AS-RORN-DAGSQR-20241028140510

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603172
Report Date: 09/19/2024
Date Signed: 09/19/2024 03:20:38 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/12/2024 and conducted by Evaluator Jose Villalobos

COMPLAINT CONTROL NUMBER: 28-AS-20240912155054

FACILITY NAME:	SAVANT OF NORWALK		FACILITY NUMBER:	198603172
ADMINISTRATOR:	CHANEL A. SANCHEZ		FACILITY TYPE:	740
ADDRESS:	11515 FIRESTONE BLVD		TELEPHONE:	(562) 379-9200
CITY:	NORWALK	STATE: CA	ZIP CODE:	90650
CAPACITY:	80	CENSUS: 78	DATE:	09/19/2024
		UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Administrator Rachelle Reyes		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff did not seek timely medical care for resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced complaint investigation visit for the allegation listed above. LPA met with administrator Rachelle Reyes and the purpose of the visit was discussed.

LPA conducted the following: Interviewed residents #2-#6 (R2-R6), resident #1 (R1) was unavailable for interview , interviewed staff #1-#6 (S1-S6) , interviewed R1's wound specialist (WS) and their agency (A1). LPA collected copies of the staff and resident roster, documents from R1's resident file which included medical reports, physicians reports, facesheet, admissions agreement, and care plan. The investigation revealed the following:

Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024

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 28-AS-20240912155054

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: SAVANT OF NORWALK	FACILITY NUMBER: 198603172
	VISIT DATE: 09/19/2024

NARRATIVE

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In regards to the allegation "Staff did not seek timely medical care for resident" it was alleged that R1 developed an open wound which went unnoticed for several days without wound care or dressing changes resulting in it becoming infested with maggots. (6) of (6) Staff denied the allegation. (5) of (5) Residents interviewed denied the allegation. Staff interviews state that R1 receives wound care from a wound specialist weekly that is covered by their insurance. R1 has been receiving wound care for several months and it is not a new condition. The wounds are non pressure related. Staff interviewed added that they do not provide wound care for residents because they are not trained for it. Only a professional is able to do that but if any immediate issues arise, they will contact the nurse on shift or the wound care agencies to determine what assistance is needed. File review shows the last date that R1 received wound care by their specialist was on 9/10/24. Notes from that visit do not show signs or maggots or infections. On this same day during the night medication shift, S6 noticed that R1 had pulled their wound bandage back revealing possible maggots under the bandage. Facility was advised to transport R1 via non emergency ambulance transportation by their doctor. Ambulance arrived on the morning of 9/11/24 to transport resident. This shows the facility sought timely medical care for resident once they were aware of issues with their wound and was not an unnoticed wound left unattended for several days. Based on the interviews, files reviewed, and observations conducted there was not enough supportive evidence to concur with the reported 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.

Exit Interviewed conducted and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024

LIC9099 (FAS) - (06/04)

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