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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603172
Report Date: 11/19/2024
Date Signed: 11/19/2024 03:24:23 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
11/15/2024 and conducted by Evaluator Alberto Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20241115140906
FACILITY NAME:SAVANT OF NORWALKFACILITY NUMBER:
198603172
ADMINISTRATOR:CHANEL A. SANCHEZFACILITY TYPE:
740
ADDRESS:11515 FIRESTONE BLVDTELEPHONE:
(562) 379-9200
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY:80CENSUS: 74DATE:
11/19/2024
UNANNOUNCEDTIME BEGAN:
09:53 AM
MET WITH:Rochalle Reyes, Executive Director and Janice Anguiano, Business Office Manger. TIME COMPLETED:
03:29 PM
ALLEGATION(S):
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Staff did not provide a statement of monthly cost upon resident's request
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alberto Lopez made unannounced visit to investigate the above allegation. LPA was greeted by Business Office Manager Janice Anguiano and Executive Director Rochalle Reyes who assisted with the visit.

The investigation consisted of interviews with three (3) staff (S#1-S#3) and seven (7) residents (R#1-R#7). LPA reviewed staff and resident rosters, R1 and R4 admission agreement, R1 updated Admission Agreement dated 11/19/2024, R1 record of Resident's Safeguarded Cash Resources, R1 Resident Statement Landscape, R1 physician's orders, R1 billing statement from 05/29/2024 to 11/05/2024. Signed copy of Resident Fund Management Service dated 12/28/2022.


(continued on 9099C)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024
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 2
Control Number 28-AS-20241115140906
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: SAVANT OF NORWALK
FACILITY NUMBER: 198603172
VISIT DATE: 11/19/2024
NARRATIVE
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(Continued from 9099)

The investigation revealed: Allegation, Staff did not provide a statement of monthly cost upon resident's request. It is alleged that facility staff were asked by R1 to provide R1 with R1 monthly cost for staying at facility and staff was not providing R1 with the information. LPA interviewed three (3) staff and all three (3) denied the allegation. S2 stated she went over the cost to with R1 just yesterday and even provided R1 with $200 for personal expense. S2 stated S2 always provides any financial information that any resident request including R1. S1 also stated that R1 has been told many times about R1 cost. R1 stated R1 had asked a few times and staff have ignored R1. Documents reviewed indicated that R1 is being provided explanation of R1 cost and expenses. LPA interviewed seven (7) residents and six (6) of seven (7) stated that they are fully aware of their financial situation and how much they pay and have full confidence in the facility and how they handle their financial affairs with them. During today's visit, R1 stated R1 is satisfied with facility. S2 created a new Admission Agreement for R1 and LPA observed R1 sign many pages and stated R1 understood what R1 was signing. LPA discussed allegation that R1 daughter took $400 without R1 consent and R1 stated that is wrong. R1 stated R1 allows R1 daughter access to R1 bank account in order to pay R1 storage fee. There is insufficient evidence to substantiate these allegation.

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.

Exit interview was conducted with Administrator Rachelle Reyes and a copy of this report was provided.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2