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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 335530032
Report Date: 02/28/2025
Date Signed: 05/05/2025 03:28:35 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
02/18/2025 and conducted by Evaluator Javier Prieto
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20250218090512
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: 154DATE:
02/28/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Marc Pacia, Executive DirectorTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
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9
Facility staff are not providing medication as prescribed

Facility staff do not ensure that residents oxygen is operable
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Javier Prieto visited the facility to investigate the allegations mentioned above. During the visit, LPA Prieto met with Executive Director Marc Pacia and outlined the details of the complaint.

Allegation #1: LPA Prieto reviewed the Physician's Orders for Resident #1 (R1), the individual involved in this case. The complaint alleged that Insulin was not being administered as prescribed. However, the Physician's Orders for R1 did not include Insulin as a prescribed medication. Wellness Supervisor (S1) confirmed that R1 neither uses nor requires Insulin.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2025
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-20250218090512
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: 02/28/2025
NARRATIVE
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 Allegation #2: S1 and Executive Director Marc Pacia (S2) confirmed that R1's portable oxygen equipment was obtained through a Durable Medical Equipment (DME) provider and is managed by the resident and/or their family. R1's needs and care plan indicate that minimum assistance with the resident's canula is required, but the overall monitor operation or functionality of portable oxygen equipment is the responsibility of the resident and/or family.

Based on the evidence gathered, there is insufficient proof to support the allegations that facility staff failed to provide medication as prescribed or to ensure that residents’ oxygen equipment was operable. As such, both allegations are deemed UNSUBSTANTIATED at this time.

This report was signed by LPA Javier Prieto and Executive Director Marc Pacia, with a copy provided to the facility.



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

DATE: 02/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2