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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 335530032
Report Date: 03/01/2024
Date Signed: 03/01/2024 03:34:05 PM


Document Has Been Signed on 03/01/2024 03:34 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507



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: 156DATE:
03/01/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Patrick McAdoo-Morton, Executive Director TIME COMPLETED:
03:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Javier Prieto made an unannounced visit to the facility to conduct a case management visit relating facility compliance, addressing complaints from residents and also a specific incident that occurred on February 28th, 2024 relating to resident #1 (R1) and the circumstances relating to R1's passing. LPA Prieto met with Administrator McAdoo-Morton and explained the purpose of the visit.

During today’s visit, LPA Prieto conducted a facility tour of the facility, dining and common areas. The physical plant was clean and in order with no deficiencies observed. LPA Prieto also interview resident counsel president (RC) who states that issues or concerns relating to the facility are gathered from resident's and are addressed with Executive Director McAdoo-Morton. RC states that those issues are addressed appropriately and timely. RC states that residents had made complaints on their own, which were not brought to RC's attention and even issues that were.

LPA Prieto obtained incident reports pertaining to R1 passing, medical reports and follow up documentation relating to grievance services provided to staff, residents and their families.

No deficiencies were cited during this visit. An exit interview was conducted with Executive Director McAdoo-Morton and a copy of this report was left with facility.

SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Javier PrietoTELEPHONE: 951-217-3135
LICENSING EVALUATOR SIGNATURE:
DATE: 03/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/01/2024
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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