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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 335530032
Report Date: 02/27/2024
Date Signed: 06/21/2024 03:37:02 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
PUBLIC
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:
02:20 PM
MET WITH:Patrick McAdoo-Morton, Executive DirectorTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff left a resident in urine and feces.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to deliver findings regarding the above listed allegations. LPA Prieto met with Executive Director Patrick McAdoo-Morton and explained the elements of the visit.

LPA interviewed staff, residents, and witness. LPA was unable to interview resident (1) due to (R1) no longer residing at the facility. LPA interviewed residents and 8 out of 8 residents revealed they have not been left in urine or feces. LPA interviewed staff, and 5 out of 5 staff denied that resident was left in urine and feces. Resident #1 (R1), in question, vacated the facility on 01/23/2024 and unable to interview.

***continued on LIC 9099C***
Unsubstantiated
Estimated Days of Completion:
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
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 3
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 that staff left a resident in urine and feces is unsubstantiated. This report was signed by LPA Prieto and Executive Director McAdoo-Moron and a copy was left with the facility.
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
LIC9099 (FAS) - (06/04)
Page: 3 of 3
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/28/2024
Section Cited
HSC
80078(a)
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80078 Responsibility for Providing Care and Supervision
(a) The licensee shall provide care and supervision as necessary to meet the client's needs.
This require was not met as evidenced by:
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Administrator agrees to meet with all care staff who provide services to residents in care and develop a definitive plan/system for how often residents on "frequent checks" and "regular checks" will be carried out. This plan should include noting who is on frequent checks
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Based on interviews, Administrator did not provide the necessary care and services to meet the needs of all residents. Residents and third party staff report requesting assistance on nurmerous occassion and received no response.
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and what staff will do for these residents. The plan should also include who is on "regular checks" and what staff will do for these residents. This plan should be put in writing and submitted to the Community Care Licensing Office within the next business day.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
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 appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3