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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 03:07:22 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
01/20/2021
and conducted by Evaluator
Wendell Smith
COMPLAINT CONTROL NUMBER:
31-AS-20210120115809
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:
12:00 PM
MET WITH:
Carolina Garcia Trejo
TIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not administering medications to residents according to physicians instructions.
Staff are not allowing resident to purchase a new bed.
Staff are not allowing resident to go outdoors.
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 subsequent complaint visit to investigate the allegations above. LPA met with the administrator and explained the reason for this visit.
Staff are not administering medications to residents according to physicians instructions.
It is alleged that the facility changed resident # 1(R1) medication without permission and R1 was not receiving their medication as prescribed. From 12:15-1:00PM LPA's reviewed R1's medication record from January to March 2021. LPA obtained copies of pertinent information related to the allegation. LPA's interviewed facility staff from 1:00-1:15pm. LPA's were not able to interview R1 due to R1 passing on 9/24/21. Interviews revealed that R1's family picked R1's pharmacy and that R1 had their own physician Based on information obtained through interviews and record review this allegation is deemed Unsubstantiated at this time.
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-20210120115809
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
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8
9
10
11
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13
14
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20
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32
Staff are not allowing resident to purchase new bed
It is alleged that facility staff would not let R1 purchase a new bed. LPA previously conducted interviews with R1's responsible person and the former administrator of the facility. Interviews revealed that R1 did provide R1 a bed when they moved in and that R1's family wanted R1 to have a different bed but wanted the facility to pay for a different bed. Administrator stated they never stopped R1's family from buying a new bed for R1. Based on the information obtained through interviews this allegation is deemed Unsubstantiated at this time. There is not enough information to state that the facility stopped R1's family from purchasing a new bed for R1.
Staff are not allowing resident to go outdoors.
It is alleged that in January 2021 R1 was having a visit with their family and wanted to go outside with their family but was denied the right to do so. LPA previously conducted interviews with the former administrator and R1's responsible person. During today's visit interviews were conducted with staff and residents regarding this allegation. Based on information obtained through interviews this allegation is deemed Unsubstantiated at this time.
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