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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 335530032
Report Date: 07/24/2025
Date Signed: 07/24/2025 04:26:46 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
05/30/2024 and conducted by Evaluator Renese Howell-Small
COMPLAINT CONTROL NUMBER: 56-AS-20240530110755
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: 144DATE:
07/24/2025
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Liz BanuelosTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Facility did not allow resident to return to facility after being discharged from a medical facility
Resident not receiving medications as prescribed
Call button not in working order for months
INVESTIGATION FINDINGS:
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On 07/24/2025 at 9:15AM Licensing Program Analyst (LPA) Renese Howell-Small conducted an unannounced visit to the facility in order to deliver findings for the above allegations. LPA discussed the purpose of the visit with Wellness Director, Liz Banuelos. The investigation consisted of interviews, record review and observation.

In regards to the allegation that facility did not allow resident to return to facility after being discharged from a medical facility:
LPA interviewed five (5) staff and reviewed records for Resident 1 (R1) and Resident 2 (R2). R1 became a resident of the facility on 11/14/2023 and voluntarily discharged on 03/21/2025. The facility submitted multiple Unusual Incident Reports (SIR) documenting that R1 was admitted to the hospital and in-house notes confirm R1's return to the facility. An interview with the relative of R1 confirmed that R1 was admitted to the hospital several times during their stay and moved out of the facility voluntarily. R2 is a current resident at the facility and LPA did not observe an Eviction letter in their file. Staff denied that the facility did not allow R1 or R2 to return to facility. Based on interviews and record review, this allegation is UNSUBSTANTIATED.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Renese Howell-Small
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025
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-20240530110755
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: 07/24/2025
NARRATIVE
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In regards to the allegation that resident is not receiving medications as prescribed:
Licensing Program Analyst (LPA) Renese Howell-Small interviewed (5) staff and ten (10) residents. Staff stated that medical technicians are trained through Relias, monthly in-services, pharmacist and hospice agencies. Staff denied not administering medications as prescribed by a physician. LPA audited the Medication Administration Record(s) (MAR) for Resident 1 (R1), Resident 2 (R2) and Resident 3 (R3). LPA did not observe any errors when the MAR was reviewed. The MAR and the facility's resident notes in the August program, indicate that R1 had a record of refusing medications and although R1 was unable to administer their own medications, kept medications in their room. All ten (10) of the residents stated that they received their medications. Staff also stated that residents may become upset when the physician adjusts their medication and the new medication has changed in appearance. Based on interview and record review, this allegation is UNSUBSTANTIATED.


In regards to the allegation that call button not in working order for months:
LPA interviewed ten (10) residents. All ten (10) of the residents stated that they have a call button and it is in working condition. LPA observed ten (10) residents interviewed to have a call button and tested random call buttons during the visit in which staff arrived to assist. LPA interviewed five (5) staff and staff stated that each resident is given a call button when hey become residents of the facility. Residents will communicate with staff if their call button is not working. Staff will test the call button and replace the battery when needed. Staff denied that call buttons have not been in working order for months. R1 received a call button but refused it, stating to staff that it was broken. Facility notes confirm that when R1 left the facility on 03/21/2025, R1 turned in their keys/pendant. Based on interviews and record review, this allegation is UNSUBSTANTIATED.


UNSUBSTANTIATED is defined as the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted where this report LIC9099 and LIC9099C was discussed and a copy was provided to staff.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Renese Howell-Small
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2