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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 335530032
Report Date: 11/08/2024
Date Signed: 02/26/2025 01:19:59 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/04/2024 and conducted by Evaluator Javier Prieto
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20241104095010
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: 146DATE:
11/08/2024
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Marc Pacia, Executive Director TIME COMPLETED:
02:55 PM
ALLEGATION(S):
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9
Facility staff do not respond to call buttons in a timely manner

Facility staff left resident on the floor for a prolonged period of time
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Javier Prieto visited the facility to conduct a complaint investigation regarding the aforementioned allegations. LPA Prieto met with Executive Director Pacia and provided an overview of the complaint elements.

Allegation #1: Facility staff do not respond to call buttons in a timely manner

LPA Prieto interviewed Resident #1 (R1), who stated that their call button was not functioning properly. LPA Prieto requested R1 to press the call button to confirm its functionality. Approximately two minutes later, a staff member arrived at R1's room, where the interview was being conducted, and manually reset R1's call button. Additionally, LPA Prieto interviewed Residents R2, R3, R4, R5, and R6. All these residents confirmed that their call buttons were working correctly and that assistance arrived promptly after the button was pressed.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2024
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-20241104095010
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 VALLEY
FACILITY NUMBER: 335530032
VISIT DATE: 11/08/2024
NARRATIVE
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Allegation #2: Facility staff left a resident on the floor for a prolonged period of time

LPA Prieto interviewed R1, who reported that a fall occurred in her bathroom on November 2, 2024. R1 stated that she pressed her call button, and approximately two minutes later, staff arrived and transported her to a medical facility. R1 returned the same day with no new orders. Records obtained for R1 indicated that she requires only moderate assistance with transfers and is capable of ambulating independently. Staff #1 (S1) provided discharge papers for R1, which recommended a follow-up with her primary care physician but noted no immediate injuries requiring attention.


LPA Prieto also interviewed Residents R2, R3, R4, R5, and R6. These residents reported no issues with falling or with staff failing to arrive promptly when a call button was pressed.

Based on the information obtained, there is insufficient evidence to substantiate the allegations that facility staff do not respond to call buttons in a timely manner or that facility staff left a resident on the floor for an extended period. Therefore, these allegations are deemed UNSUBSTANTIATED at this time. This report was signed by LPA Prieto and Executive Director Pacia.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2