197608081-3-17-2022-31-AS-EMIR-CCYV98-20220329161352

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608081
Report Date: 03/17/2022
Date Signed: 03/17/2022 02:58:49 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
03/10/2022 and conducted by Evaluator Michael Cava

COMPLAINT CONTROL NUMBER: 31-AS-20220310161117

FACILITY NAME:	AVANTGARDE SENIOR LIVING OF TARZANA		FACILITY NUMBER:	197608081
ADMINISTRATOR:	CAROLINA GARCIA-TREJO		FACILITY TYPE:	740
ADDRESS:	5645 LINDLEY AVENUE		TELEPHONE:	(818) 881-0055
CITY:	TARZANA	STATE: CA	ZIP CODE:	91356
CAPACITY:	138	CENSUS: 108	DATE:	03/17/2022
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Carol Trejo		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility has insects

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Gary Tan and Michael Cava conducted a complaint visit to facility to investigate the above allegation. LPAs met with the administrator, Carol Trejo, and explained to her the purpose of the day's visit. It's being alleged that the facility has fleas and it was observed in the resident's room, bed and carpeting. Today's investigation consisted of resident and staff interviews, a physical plant inspection of resident rooms and common areas, and record review.

According to staff, on or around 3/11/22, R1 was noticed to be scratching self. When staff assessed R1, they did observe fleas and eggs on her. Home Health was notified, prescription and treatment was applied. Staff stated additional flea medication was prescribed and will be applied to R1 every seven days. Staff stated R1's roommate, Resident 2 (R2) was also assessed and was observed with flea eggs. R2 was also given treatment and prescription. In addition to getting both residents treated for fleas, their room was disinfected and their clothing, blankets and bedsheets were washed. As a preventive measure, for

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 03/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2022

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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Control Number 31-AS-20220310161117

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: 03/17/2022

NARRATIVE

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any spread of fleas throughout the facility, both R1 and R2 were quarantined temporarily. Their responsible parties were notified, and they didn't express any complaints or concerns. Administrator and staff were asked if the other residents in the facility were affected, and they denied other residents being affected. The source of the fleas may have come from R1 during an outing as until then (on or around 3/11/22), the facility had no issues with fleas. LPAs interviewed random residents, and they denied ever having fleas during their stay at the facility.

Review of records indicate that the licensee contracts with ORKIN for monthly service as preventive measures for insects. Review of the invoice did not reveal any outbreak of pest or insects. LPAs also reviewed Home Health records which indicates that they were notified of R1's situation and assisted in providing R1 with treatment.

Although two residents were reported to have fleas, the licensee acted accordingly in providing both residents treatment in preventing the spread of fleas throughout the facility. Therefore, based on the information obtained, the allegation is Unsubstantiated at this time.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 03/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2022

LIC9099 (FAS) - (06/04)

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