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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 335530032
Report Date: 11/28/2023
Date Signed: 11/28/2023 02:06:00 PM


Document Has Been Signed on 11/28/2023 02:06 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:SAVANT OF JURUPA VALLEYFACILITY NUMBER:
335530032
ADMINISTRATOR:PENDINGFACILITY TYPE:
740
ADDRESS:5881 EL PALOMINO DRIVETELEPHONE:
(951) 683-3333
CITY:RIVERSIDESTATE: CAZIP CODE:
92509
CAPACITY:197CENSUS: 143DATE:
11/28/2023
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Executive Director Patrick McAdoo-MortonTIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Mary Rico conducted an unannounced case management pertaining to the old facility Villa De Anza Assisted Living 331800471 regarding their four (4) complaints. 18-AS-20210719133022 18-AS-20210609144620 18-AS-20210716151500 18-AS-20210706142605

An exit interview was conducted where this report (LIC809) was discussed and provided to Executive Director Patrick McAdoo-Morton.

SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Mary RicoTELEPHONE: (951) 248-0293
LICENSING EVALUATOR SIGNATURE:
DATE: 11/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/28/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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