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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 335530032
Report Date: 12/08/2023
Date Signed: 03/06/2025 02:34:31 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/06/2023 and conducted by Evaluator Javier Prieto
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20231206111059
FACILITY NAME:SAVANT OF JURUPA VALLEYFACILITY NUMBER:
335530032
ADMINISTRATOR:PATRICK L. MCADOO-MORTONFACILITY TYPE:
740
ADDRESS:5881 EL PALOMINO DRIVETELEPHONE:
(951) 683-3333
CITY:RIVERSIDESTATE: CAZIP CODE:
92509
CAPACITY:197CENSUS: 142DATE:
12/08/2023
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Marc Pacia, Executive DirectorTIME COMPLETED:
04:30 PM
ALLEGATION(S):
1
2
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5
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8
9
#1 Staff not giving medication to a resident as prescribed.

#2 Staff not assisting resident in a timely manner
INVESTIGATION FINDINGS:
1
2
3
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5
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7
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9
10
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13
 Licensing Program Analyst (LPA) Javier Prieto arrived at the facility to initiate a complaint investigation regarding the allegations mentioned above. LPA Prieto met with Executive Director Morton and discussed the elements of the complaint.

Allegation #1: LPA Prieto reviewed the Medical Administration Records (MAR) log for resident #1 (R1), revealing that medications are being dispensed as prescribed. An interview with Wellness Director (S1) confirmed that medications are being dispensed as prescribed and that any refusal of medication is documented. During an interview with R1, it was revealed that the medications listed on her Physician's Orders are being dispensed properly. R1 admitted to LPA that she sometimes refuses to take pain medication, even though it is documented in her Physician's Orders.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2023
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 56-AS-20231206111059
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: SAVANT OF JURUPA VALLEY
FACILITY NUMBER: 335530032
VISIT DATE: 12/08/2023
NARRATIVE
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Allegation #2: In an interview with R1, it was revealed that she makes calls to the front office from her cellphone when assistance is needed. R1 also mentioned that she uses her room call button for assistance when it is within reach, as her hands are constricted.

During an interview with Executive Director Morton, it was concluded that R1 was receiving hourly checks by staff in addition to the medical staff dispensing her medication three times per day. R1 pressed her call button in the presence of LPA, and staff entered the room to address the call within approximately three minutes.

LPA conducted interviews with residents 1 through 10, which revealed that staff are dispensing medications as prescribed and providing assistance in a timely manner.

Based on the information obtained, there is not enough evidence to support the allegations that staff are not dispensing medication as prescribed and not assisting residents in a timely manner. Therefore, the allegations are deemed UNSUBSTANTIATED at this time.

This report was signed by LPA Prieto and Director Morton, and a copy was left at the facility.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2