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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 335530032
Report Date: 09/05/2024
Date Signed: 09/05/2024 03:51:49 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 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
08/27/2024 and conducted by Evaluator Lavette Farlow
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240827091058
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: 158DATE:
09/05/2024
UNANNOUNCEDTIME BEGAN:
01:49 PM
MET WITH:Patrick McAdoo-Morton, Regional Director TIME COMPLETED:
04:05 PM
ALLEGATION(S):
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Staff did not ensure facility was free of pests
INVESTIGATION FINDINGS:
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Licensing Program Analyst's (LPA) LaVette Farlow and (LPA) Javier Prieto arrived to the facility to conduct a complaint investigation regarding the above allegation. (LPA) Farlow and LPA Prieto met with Executive Director Patrick McAdoo-Morton and explained the elements of the complaint.

Regarding the allegation that staff did not ensure facility was free of pests to the resident in care; LPA's Farlow and Prieto interviewed resident #1, in question, who states that the facility is not addressing the pest problem and there are roaches in the facility. During the visit LPA's Farlow and Prieto completed a tour of the facility and observed a company name BugFree Central, Inc was present to conduct a weekly pest control. LPA's Farlow and Prieto did complete a visit to R1 room and observed several mouse traps in the room.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Lavette Farlow
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024
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-20240827091058
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: SAVANT OF JURUPA VALLEY
FACILITY NUMBER: 335530032
VISIT DATE: 09/05/2024
NARRATIVE
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LPA's conducted interviews with several staff. Interview with Staff S1, explained that the facility is currently providing preventative measure to address the pest issues. S1 stated that Orkin comes monthly for treatment at the facility and BugFree Central Inc comes weekly for treatment. Also, the facility has conducted extra cleaning and treatment for those residents that had extra clutter weekly. Documentation was obtained from the Business Manager Danielle Garcia for this report.

Based on the information obtained there is not enough evidence that staff did not providing preventative measure to address the pest issue for resident in care. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. This report was signed by LPA's Farlow and Prieto and Business Manager Danielle Garcia and a copy was left with the facility.


SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Lavette Farlow
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2