197608081-3-17-2022-31-AS-EMIR-CCZSHN-20220330135345

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608081
Report Date: 03/17/2022
Date Signed: 03/17/2022 02:55:18 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
03/11/2022 and conducted by Evaluator Michael Cava

COMPLAINT CONTROL NUMBER: 31-AS-20220311130718

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 not keeping residents room free from pests.
Staff isolates residents.

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. Today's investigation consisted of resident and staff interviews, a physical plant inspection of resident rooms and common areas, and record review.

Facility not keeping residents room free from pests:
In regards to the allegation, it's alleged that facility has cockroaches and lice. This investigation is made in conjunction to complaint control # 31-AS-20220310161117, allegation facility has insects. LPAs conducted interviews and record review to address the concern. 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.

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-20220311130718

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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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. When asked about cockroaches, residents could not recall and denied the allegation that there are cockroaches. LPAs interviewed random residents, and they denied ever having fleas or roaches 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 these invoice did not reveal any outbreak of pest or insects.

Based on the information obtained, there wasn't enough evidence to corroborate the allegation that licensee is not keeping resident rooms free of pests. Therefore, the allegation is deemed Unsubstantiated at this time.

Staff isolates residents:
In regards to the allegation, it was reported that the head nurse is isolating residents. Because two residents were noted to have fleas, according to staff and residents, as a preventive measure, for 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. Both R1 and R2 were interviewed to address the allegation. Both residents denied ever being isolated.

Based on the information obtained, there wasn't enough evidence to corroborate the allegation of staff isolating residents. Therefore, the allegation is deemed 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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