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Department of
SOCIAL SERVICES
Community Care Licensing
COMPLAINT INVESTIGATION REPORT
Facility Number:
197608081
Report Date:
10/05/2021
Date Signed:
10/05/2021 03:06:25 PM
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office
,
21731 VENTURA BLVD., STE. 250
WOODLAND HILLS
,
CA
91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/29/2021
and conducted by Evaluator
Wendell Smith
COMPLAINT CONTROL NUMBER:
31-AS-20210929150409
FACILITY NAME:
AVANTGARDE SENIOR LIVING OF TARZANA
FACILITY NUMBER:
197608081
ADMINISTRATOR:
ERIN MAHONEY
FACILITY TYPE:
740
ADDRESS:
5645 LINDLEY AVENUE
TELEPHONE:
(818) 881-0055
CITY:
TARZANA
STATE:
CA
ZIP CODE:
91356
CAPACITY:
138
CENSUS:
104
DATE:
10/05/2021
UNANNOUNCED
TIME BEGAN:
09:30 AM
MET WITH:
Carolina Garcia-Trejo
TIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility did not issue Resident's Representative a refund.
Facility did not provide Resident's Representative written notice of policies regarding contract termination upon death in a timely manner.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst(s) Wendell Smith and LaQueena Lacy conducted an unannounced initial complaint visit to investigate the allegations above. LPA met with the administrator and explained the reason for this visit.
Upon entry to the facility a physical plant tour was conducted from 9:45am-10:00 am to ensure no immediate health and safety issues. No immediate health and safety issues were noted during the walk through.
Facility did not issue Resident's Representative a refund
Regarding this allegation it is alleged that resident # 1(R1) rent was paid in advance for October 2021 and that R1 passed away on 9/24/21 and the facility has not issued a refund for the October 2021 payment. LPA's conducted interviews with the administrator and facility staff regarding this allegation from 10-10:20am. LPA's reviewed R1's facility file and obtained copies of pertinent information related to R1's file from 10:20-11:00am.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME:
Cassandra Harris
TELEPHONE:
(818) 596-4342
LICENSING EVALUATOR NAME:
Wendell Smith
TELEPHONE:
(818) 738-4525
LICENSING EVALUATOR SIGNATURE:
DATE:
10/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/05/2021
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
31-AS-20210929150409
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office
,
21731 VENTURA BLVD., STE. 250
WOODLAND HILLS
,
CA
91364
FACILITY NAME:
AVANTGARDE SENIOR LIVING OF TARZANA
FACILITY NUMBER:
197608081
VISIT DATE:
10/05/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
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31
32
Information obtained from interviews with facility staff and R1's responsible person revealed that R1 passed away on 9/24/21. At that point R1's rent for September 2021 was already paid. R1's responsible person received a pro-rated check from the facility in the amount of 217.80 dollars for the pro-rated amount for September 2021. LPA's obtained and reviewed Billing invoices for R1. It shows that R1's rent for October 2021 had not been paid as of yet. Based on the information obtained through interviews and record review this allegation is deemed Unsubstantiated at this time.
Facility did not provide Resident's Representative written notice of policies regarding contract termination upon death in a timely manner.
It is alleged that R1's responsible person have not received any written notice regarding fees assessed after R1 passed and their property remained in the unit. LPA's conducted interview with the administrator and reviewed R1's facility file. Information revealed that R1's responsible party was not charged any fees after R1 passed. R1's family came to the facility on the day R1 passed and took the personal belongings they wanted and the rest of what they did not want they said could be donated. Based on the information obtained through interviews this allegation is deemed Unsubstantiated. No additional fees were charged after R1 passed away.
Exit Interview conducted.
SUPERVISOR'S NAME:
Cassandra Harris
TELEPHONE:
(818) 596-4342
LICENSING EVALUATOR NAME:
Wendell Smith
TELEPHONE:
(818) 738-4525
LICENSING EVALUATOR SIGNATURE:
DATE:
10/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/05/2021
LIC9099
(FAS) - (06/04)
Page:
2
of
2