197608081-2-1-2022-31-AS-EMIR-CBQVTL-20220217154315

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608081
Report Date: 02/01/2022
Date Signed: 02/01/2022 03:31:05 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
01/31/2022 and conducted by Evaluator Wendell Smith

COMPLAINT CONTROL NUMBER: 31-AS-20220131121000

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: 112	DATE:	02/01/2022
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Carolina Garcia-Trejo		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility did not issue refund to resident's POA

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Wendell Smith made an unannounced complaint visit to investigate the allegation above. LPA met with the administrator and explained the reason for this visit.
Regarding the allegation it is alleged that resident #1 (R1) moved out and the facility did not refund R1's pre-admission fee. LPA interviewed the administrator regarding this allegation from 1:30-1:45pm. LPA also reviewed R1's admission agreement from 1:45-2:10pm. LPA also interviewed R1's responsible person regarding this allegation. Information from a review of R1's admission agreement found that if the resident has lived in the facility for four or more months, the licensee may, but is not required to make a refund of the preadmission fee. It was noted that R1 lived in the facility from 7/5/21 through 1/13/22 which is more that four months. Based on the information obtained this allegation is deemed Unsubstantiated at this time.
Exit Interview conducted.

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: 02/01/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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