198603597-9-3-2024-28-AS-LHIS-D8YNVR-20240910104821

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603597
Report Date: 09/03/2024
Date Signed: 09/03/2024 01:32:28 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
08/23/2024 and conducted by Evaluator Alberto Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240823100907

FACILITY NAME:	SAVANT OF ALHAMBRA		FACILITY NUMBER:	198603597
ADMINISTRATOR:	PHAM, LISA		FACILITY TYPE:	740
ADDRESS:	1 E COMMONWEALTH AVE		TELEPHONE:	(626) 289-3871
CITY:	ALHAMBRA	STATE: CA	ZIP CODE:	91801
CAPACITY:	176	CENSUS: 118	DATE:	09/03/2024
		UNANNOUNCED	TIME BEGAN:	09:26 AM
MET WITH:	Lisa Pham, Administrator		TIME COMPLETED:	01:39 PM

ALLEGATION(S):

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Facility staff not assisting resident with attending dialysis appointments as required

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alberto Lopez made an unannounced subsequent complaint visit at the facility for the purpose of investigating the above-mentioned allegation. LPA Lopez met with Ruby Andrade, Business Manager and explained the purpose for the visit. Administrator Lisa Pham arrived a few minutes later and assisted with the visit.

On previous visit on 08/26/2024 LPA Lopez obtained a copy of the resident/staff roster. Toured common areas and Interviewed one (1) Staff (S#1)

The investigation consisted of LPA interviewing four (4) staff and eight (8) residents. LPA reviewed and obtained 3 SIR dated 08/19/2024, 08/21/2024, and 08/23/2024 in which department is notified of R1 refusal to go to dialysis, progress notes from 08/14/2024 to 09/3/2024, R1 LIC602, and R1 History and Physical dated 08/22/2024.
(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: 09/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2024

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-20240823100907

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 ALHAMBRA	FACILITY NUMBER: 198603597
	VISIT DATE: 09/03/2024

NARRATIVE

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The Investigation reveled the following:

Allegation: Facility staff not assisting resident with attending dialysis appointments as required. It is alleged that facility is not assisting R1 in getting to R1 appointments for dialysis. LPA interviewed four (4) staff and all four (4) staff denied the allegation and all four stated that R1 has refused to attend R1 appointments for dialysis and that R1 primary doctor is notified each time. LPA interviewed eight (8) residents and all eight (8) residents could not corroborate the allegation. LPA spoke with R1 via phone and stated that R1 refused to attend dialysis and did not blame the facility. LPA reviewed SIR dated 08/19/2024, 08/21/2024, and 08/23/2024 and it all three, the facility has reported R1 refusal to attend dialysis. LPA reviewed History and Physical report dated 08/22/2024 in which it reports that R1 has capacity to make medical decisions on R1 own behalf and R1 is not having memory loss. The report also mentions R1 intermittently refused dialysis while hospitalized from 08/14/2024 - 08/18/2024. There is no evidence to substantiated this 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 allegations are UNSUBSTANTIATED.

Exit interview was conducted, a copy of this report and Appeal Rights were provided to Lisa Pham, Administrator

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2024

LIC9099 (FAS) - (06/04)

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