198603172-9-30-2024-28-AS-RORN-DABTAW-20241023143413

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603172
Report Date: 09/30/2024
Date Signed: 09/30/2024 04:44:34 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
09/23/2024 and conducted by Evaluator Tyler Reyes

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240923120900

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:	09/30/2024
		UNANNOUNCED	TIME BEGAN:	09:11 AM
MET WITH:	Administrator Rachelle Reyes		TIME COMPLETED:	04:50 PM

ALLEGATION(S):

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Staff contaminated residents medication
Staff do not ensure medications are dispensed as prescribed
Staff do not ensure resident is provided with assistance for medical and dental appointments

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tyler Reyes conducted an unannounced initial complaint visit to determine the validity of the above-mentioned allegations. LPA met with Administrator Rachelle Reyes and explained the reason for the visit.

The investigation consisted of the following: During the visit, LPA interviewed Resident #1 (R1 – R6) and Staff #1 (S1-S5). LPA requested copies of the resident roster, staff roster, and the Physician’s Reports LIC 602A, MARs, and Onsite Skilled Dental Care visits.

The investigation revealed the following: regarding the allegation “Staff contaminated residents’ medication”, it is alleged that facility staff are altering the prescription medication which in return is causing irritation.

--Continued LIC 9099-C--

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Tyler Reyes
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2024

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-20240923120900

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: SAVANT OF NORWALK	FACILITY NUMBER: 198603172
	VISIT DATE: 09/30/2024

NARRATIVE

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(5) of (5) staff denied the allegation. Staff indicated that they have not witnessed any alterations to the prescribed medication nor heard of any other staff altering medications in a manner different from the way it was prescribed by the doctor. All medication have been administered according to the doctor's orders, and no unauthorized modifications have been made. (6) of (6) residents denied the allegation. Residents indicated they have not experienced any similar effects or issues with their prescribed medication. All residents confirmed that their medication have been administered as prescribed by their doctors without any changes. LPA Reyes contacted the pharmacist regarding (3) residents who are taking similar medication. The pharmacist confirmed that, despite different manufactures, the medication is the same brand and contains the same active ingredients. LPA Reyes observed and examined with S2 the alleged victims medication and found it to be sealed and with no signs of alteration.

The investigation revealed the following: regarding the allegation "Staff do not ensure medications are dispensed as prescribed", it is alleged that facility staff are dumping medication out and replacing medication with another substance. (5) of (5) staff denied allegation. Staff have not witnessed nor heard of any staff not administering resident's medication as prescribed by a physician. All medication have been administered according to the doctor's orders, and no unauthorized modifications have been made. (6) of (6) residents denied the allegation. Residents have indicated they do receive their medication as prescribed and have not experienced any changes. LPA Reyes reviewed the alleged victims Mars and received confirmation from alleged victim that have stopped taking medication.

The investigation revealed the following: regarding the allegation "Staff do not ensure resident is provided with assistance for medical and dental appointments" , it is alleged that medical documents are being taken from their room which in return is causing the resident to miss medical appointments. (5) of (5) staff denied the allegation. Staff indicated that after a visit is conducted by the dentist their paper work is then given to a staff for filing. If a resident does request a copy of recent visit a copy is provided. LPA Reyes spoke with (2) employees of Onsite Skilled Dental Care and confirmed that after a visit is completed paper work is provided only to a staff member. (6) of (6) residents have denied the allegation. Residents have indicated that they do not receive paper work from the dentist that it is provided to a staff member. The medical paper work they have obtained has not been taken from their room. It was reported to LPA Reyes that the alleged victim does have some memory issues. LPA Reyes reviewed alleged victim's LIC 602A and they do suffer from cognitive impairment.

--Continued LIC 9099-C--

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Tyler Reyes
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2024

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20240923120900

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: SAVANT OF NORWALK	FACILITY NUMBER: 198603172
	VISIT DATE: 09/30/2024

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	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 allegations are unsubstantiated. Exit interview was conducted with Administrator Rachelle Reyes and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Tyler Reyes
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2024

LIC9099 (FAS) - (06/04)

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