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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603597
Report Date: 04/28/2025
Date Signed: 04/28/2025 01:36:20 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
04/21/2025 and conducted by Evaluator Alberto Lopez
COMPLAINT CONTROL NUMBER: 28-AS-20250421133503
FACILITY NAME:SAVANT OF ALHAMBRAFACILITY NUMBER:
198603597
ADMINISTRATOR:MADELEINE SIEVERTFACILITY TYPE:
740
ADDRESS:1 E COMMONWEALTH AVETELEPHONE:
(626) 289-3871
CITY:ALHAMBRASTATE: CAZIP CODE:
91801
CAPACITY:176CENSUS: 143DATE:
04/28/2025
UNANNOUNCEDTIME BEGAN:
10:02 AM
MET WITH:Madeline Sievert, AdministratorTIME COMPLETED:
01:41 PM
ALLEGATION(S):
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Allegation: Staff did not meet resident's hygiene needs.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alberto Lopez made an unannounced initial visit to investigate the above allegation. LPA met with Regional Director Lisa Pham and Administrator Madeline Sievert and discussed the purpose of the visit.

The investigation consisted of LPA interviewing six (6) staff and eleven (11) residents. Taking tour of facility, reviewing and obtaining staff and resident rosters, R1 face sheet, R1 Physicians report, R1 Admission agreement, and resident service refusal log.

The investigation revealed: Allegation, Staff did not meet resident's hygiene needs. It is alleged the facility has failed to provide proper hygiene services to R1, that R1 was observed with dead skin on body and mold fuzz between R1 toes.

(continue 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: 04/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2025
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-20250421133503
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: 04/28/2025
NARRATIVE
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(continued from 9099)

LPA interviewed six (6) staff and six (6) of six (6) staff denied the allegation. All six (6) staff stated that resident refuses hygiene/bathing services almost always. One staff stated that R1 has refused at least 6 six times when staff has been scheduled to assist R1. One staff stated that R1 can bathe self, and that staff are assigned to be on standby for R1. LPA interviewed eleven (11) residents and ten (10) of Eleven (11) residents could not corroborate the allegation. R1 stated staff do not come to assist R1 with bathing or personal hygiene. R1 stated R1 never refuses personal hygiene or bathing services. R1 stated R1 wants personal hygiene assistance. R1 stated R1 has no dead skin or uncleaned feet and toes. LPA reviewed and obtained facility shower refusal forms for R1 dated 02/01/2025, 02/18/2025, 02/21/2025, 03/14/2025, 03/21/2025, 03/25/2025, 03/28/2025, 04.01/2025 and 04/08/2025 which contradicts R1 statements. S2 stated R1 has history of fabricating events. R1 was hospitalized from 04/09/2025 to 04/14/2025 and then was sent back to hospital on 04/17/2025 and remains hospitalized to date. R1 appeared to be clean in facetime call from hospital that R1 is currently at.

Based on interviews conducted and records reviewed, there is insufficient evidence to support the allegations. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.

An exit interview was conducted, and a copy of this report was given to Administrator Madeleine Sievert.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2