<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES
Community Care Licensing
COMPLAINT INVESTIGATION REPORT
Facility Number:
197608081
Report Date:
11/19/2021
Date Signed:
11/19/2021 04:37:21 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
11/03/2021
and conducted by Evaluator
Wendell Smith
COMPLAINT CONTROL NUMBER:
31-AS-20211103144234
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:
116
DATE:
11/19/2021
UNANNOUNCED
TIME BEGAN:
11:00 AM
MET WITH:
Carolina Garcia-Trejo
TIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff left residents in soiled diapers for an extended period of time
Staff did not administer residents medication in a timely manner
Facility is understaffed
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced subsequent complaint visit to finish investigation into the allegations above. LPA met with the administrator and explained the reason for this visit.
LPA conducted a physical plant tour to ensure no immediate health and safety concerns from 11:10-11:30am.
Staff left residents in soiled diapers for an extended period of time
it is alleged that residents are not being changed in a timely manner. LPA conducted an intial visit on 11/5/21 where LPA conducted interviews with residents regarding this allegation. During today's visit LPA interviewed residents who require assistance with incontinent care from 12pm-2pm. Interviews revealed that residents are satisfied with the time it is taking to get changed when they need assistance. Based on the information obtained through interviews 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:
11/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/19/2021
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-20211103144234
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:
11/19/2021
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
30
31
32
Staff did not administer residents medication in a timely manner
It is alleged that staff are not getting their medication in a timely manner. LPA conducted interviews with residents from 12pm-2pm and staff from 2-3pm regarding this allegation. Interviews revealed that residents are receiving their medication at a scheduled time and that there have been no issues with medication being given. Based on the information obtained through interviews this allegation is deemed Unsubstantiated at this time.
Facility is understaffed
It is alleged that the facility does not have enough staff and that staff are working from 6am-6pm consistently. LPA conducted interviews with residents and staff regarding this allegation from approximately 12-3pm. LPA also obtained a staff schedule to show coverage for the facility. Based on the information obtained through interviews and schedule review 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:
11/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/19/2021
LIC9099
(FAS) - (06/04)
Page:
2
of
2