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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 335530032
Report Date: 02/27/2024
Date Signed: 02/27/2024 02:28:34 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/24/2024 and conducted by Evaluator Amber Coleman
COMPLAINT CONTROL NUMBER: 56-AS-20240124173434
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: 153DATE:
02/27/2024
UNANNOUNCEDTIME BEGAN:
01:45 AM
MET WITH:Patrick McAdoo-Morton, Executive DirectorTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Staff dispensed medications not prescribed to a resident.
Staff dispensed a medication to a resident that they are allergic to.
Resident sustained a pressure injury while in care.
Staff did not ensure that a resident is fed while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst, Amber Coleman, (LPA) arrived at the Savant of Jurupa Valley to deliver findings of the complaint investigation into the above listed allegations. LPA introduced self and stated purpose of the visit, then met with Executive Director, Patrick McAdoo-Morton. During the investigation, LPA collected records for review, interviewed staff, residents and witnesses, and completed a walk through of the facility.

It is alleged that staff dispensed medications not prescribed to a resident. Staff interviewes revealed that the facility does not regulary administer medications of narcotic class to its residents. Staff also completed an investigation of their own which accounted for all resident medications. No medication were determined to be missing. A review, of R1's Medication Administrative Record, (MARS) revelead R1 has missed no medications.

It is alleged that staff dispensed a medication to a resident that they are allegic to. A review of R1's Medication Administrative Record, (MARS) revealed that R1 was not dispensed a medication she was allegeric to nor fentanyl or opiates. Which reported to show up on R1's drug screen.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Amber ColemanTELEPHONE: 951-248-0338
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024
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-20240124173434
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 VALLEY
FACILITY NUMBER: 335530032
VISIT DATE: 02/27/2024
NARRATIVE
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Based on staff and resident interviews, the allegation staff left a resident in urine and feces is unsubstantiated. This report was signed by LPA Prieto and Executive Director McAdoo-Morton and a copy was left with the facility.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Javier PrietoTELEPHONE: 951-248-0338
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2