198603597-7-10-2025-28-AS-MGFS-DJPMB8-20250718092728

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603597
Report Date: 07/10/2025
Date Signed: 07/10/2025 11:59:46 AM

Substantiated

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
03/27/2025 and conducted by Evaluator Nicol Wesley

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250327140118

FACILITY NAME:	SAVANT OF ALHAMBRA		FACILITY NUMBER:	198603597
ADMINISTRATOR:	MADELEINE SIEVERT		FACILITY TYPE:	740
ADDRESS:	1 E COMMONWEALTH AVE		TELEPHONE:	(626) 289-3871
CITY:	ALHAMBRA	STATE: CA	ZIP CODE:	91801
CAPACITY:	176	CENSUS: 143	DATE:	07/10/2025
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Madeleine Sievert		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Staff do not meet resident's basic needs due to insufficient staffing.
Staff do not keep resident's room clean & sanitary.

INVESTIGATION FINDINGS:

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**This LIC 9099/LIC 9099C/LIC 9099D supersedes the LIC 9099/LIC 9099C/LIC 9099D that was issued on 05/16/25**
Licensing Program Analyst (LPA) Nicol Wesley conducted a subsequent visit at the facility and met with Administrator Madeleine Sievert to discuss the purpose of the visit.
Investigation consisted of: staff roster, resident roster, incontinence records, house keeping records, interviewed 3 staff, interviewed 15 residents, walked around and toured the facility.
Investigation revealed:
Regarding allegation: Staff do not meet resident's basic needs due to insufficient staffing, and Staff do not keep resident's room clean & sanitary. On 04/03/25, LPA Wesley and the Administrator Madeleine Sievert toured the facility and found that several rooms were not cleaned Room #104, 105, 108,113, 123, 134, 135, 152 & 230. LPA asked the administrator how many staff were on duty and she provided me with the names 2 med technicians, 5 caregivers, 2 housekeepers, and 1 laundry attendant on duty. LPA visited random
Continued on LIC 9099C

Substantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Nicol Wesley
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2025

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-20250327140118

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 ALHAMBRA	FACILITY NUMBER: 198603597
	VISIT DATE: 07/10/2025

NARRATIVE

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clients rooms and found that the trash was not emptied, restroom has not been cleaned, and their linen was not changed, as well as resident #1 was in a soiled undergarment. Pictures were taken. LPA Wesley interviewed 2 out of 3 direct support staff and they indicated that they are short staff and are in need of help. and 1 out of 3 answered "I'm okay." There was some random people visiting their loved ones and they indicated that they come and clean the rooms, sweep and take their trash away. LPA Wesley interviewed 15 residents and they said there rooms are supposed to be cleaned once a week, linen changed once a week or as needed, and trash is to be emptied daily. There were 12 out of 15 residents who said there rooms are not cleaned/linen changed weekly or as needed, nor are their trash cans emptied daily. There were 3 out of 15 residents didn't want to comment. LPA Wesley and Administrator Sievert observed the rooms were not clean and sanitary. On 04/03/25, LPA Wesley was at the facility from 11:20am-4:30pm. Pictures were taken.

Based on LPAs observations and interviews which were conducted record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be substantiated. California Code of Regulations, Title 22, Division 6 chapter 8 are being cited on the attached LIC 9099D.

Appeal rights were given. A copy of the LIC 9099/LIC 9099C/LIC 9099D was given to the administrator during the exit interview.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Nicol Wesley
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2025

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20250327140118

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 ALHAMBRA	FACILITY NUMBER: 198603597
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/10/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Request Denied Type B 07/10/2025 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	Maintenance and Operation The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.	1 2 3 4 5 6 7	The administrator shall ensure all the residents rooms are clean. Create an inservice training "Maintenace and Operations" for all staff and go over what needs to be cleaned, incase they don't understand their dutied. The facility will hire more staff if necessary.
	8 9 10 11 12 13 14	This evidence was not met as required LPA and the Administrator observed several rooms that were not cleaned by staff, which includes emptying the trash, cleaing the bathrooms, and changing the linen. which poses a health and safety issue for all clients in care.	8 9 10 11 12 13 14	Submit the in service training sign in sheet to LPA Wesley 323 980 4912 by the POC date 07/11/25.
Deficiency Dismissed Type B 07/10/2025 Section Cited CCR 87625(b)(3)	1 2 3 4 5 6 7	Managed Incontinence, In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence.	1 2 3 4 5 6 7	The facility Administator will ensure all residents diaper/undergarment will be changed and monitored every two hours or as needed. The Administrator will have a log of all the residents who are incontinent and have the staff initial when they have been checked.
	8 9 10 11 12 13 14	LPA Wesley and Administrator Sievert observed Resident #1 to be in a soiled diaper/undergarment, when asked, he mentioned last night sometime, the Administrator said she dont remember this conversation. Which poses a health and safety issue to clients in care.	8 9 10 11 12 13 14	Send the incontinence log to LPA Wesley by POC date 07/17/25.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Nicol Wesley
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2025

LIC9099 (FAS) - (06/04)

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