197608081-4-15-2022-31-AS-EMIR-CDXTEY-20220429144041

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608081
Report Date: 04/15/2022
Date Signed: 04/15/2022 02:50:23 PM

Unsubstantiated

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
09/14/2020 and conducted by Evaluator Michael Cava

COMPLAINT CONTROL NUMBER: 31-AS-20200914160454

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: 111	DATE:	04/15/2022
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Carolina Garcia-Trejo		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff failed to protect resident from being harmed by another resident.
Staff failed to destroy the non-active medications in the facility.
Residents receiving hospice care without a cause.
Administrator is not available at the facility.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Michael Cava conducted a complaint visit to the facility to conclude the investigation regarding the allegations above. LPA met with the administrator, Carolina Garcia-Trejo and advised her of the investigation which consisted of interviews with residents, staff and record review.

Staff failed to protect resident from being harmed by another resident:
In regards to the allegation, it's being reported that Resident 1 (R1) is physically abusive towards staff and other residents, but staff are not doing anything to protect the other residents. It's also alleged that R1 had bitten another resident. Interviews with staff and residents do not corroborate with the allegation. Furthermore, when an interview was held with the reporting party (RP), they could not provide any witnesses vicitms, date and time of when R1 was aggressive towards other residents. Furthermore, RP could not confirm R1 biting another resident as they did not physically witness the incident. Based on the information obtained, there was insufficient evidence to corroborate the allegation of staff failing to protect

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: 04/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2022

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-20200914160454

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: 04/15/2022

NARRATIVE

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another resident from R1's harm. Therefore, the allegation is deemed Unsubstantiated at this time.

Staff failed to destroy the non-active medications in the facility:
In regards to the allegation, it was reported that Staff 1 (S1) is not properly destroying medications. S1 keeps expired narcotics in her desk drawer and doesn't keep the refrigerator locked when medications like liquid Morphine or Ativan is being stored there. During the investigation, LPA toured the medication room and did not observe expired narcotics being maintained in the premises at all. There were cabinets and drawers were locked. When asked to open and inspect, no medicine was observed inside. The refrigerator was inspected to insure that locks were in place and maintained when storing any Morphine or Narcotic. In addition to the medication inspection, LPA obtained record copies of centrally stored medication for destruction and disposal for review. No discrepancy observed. Based on the information obtained, there was insufficient evidence to corroborate the allegation of staff failing to destroy the non-active medications in the facility. Therefore, the allegation is deemed Unsubstantiated at this time.

Residents receiving hospice care without a cause:
In regards to the allegation, it was reported that that certain residents receive hospice care, but do not need the services. During the investigation, LPA received a list of the facility's hospice care residents. LPA interviewed staff and obtained hospice records for these residents to confirm hospice services was needed and ordered by their physician. Facility has a hospice waiver for 25. Currently there are 23 residents receiving hospice care. Based on the information obtained, there was insufficient evidence to corroborate the allegation of residents receiving hospice care without cause. Therefore, the allegation is deemed Unsubstantiated at this time.

Administrator is not available at the facility:
In regards to the allegation, it was alleged that the former administrator, Erin Mahoney, goes to the La Jolla facility every other week. Ms. Mahoney was interviewed by LPA Manya Lefian on 9/18/20. Ms. Mahoney confirmed that she goes to La Jolla twice a week, but there is always sufficient coverage when she is at the La Jolla facility. An LIC 308 was obtained at the time of the initial visit to this investigation indicating that current administrator, Carol Garcia-Trejo and Jason Frahm would cover in place of Ms. Mahoney. A copy of the LIC 500 was also obtained to confirm staff coverage. Mrs. Garcia-Trejo also confirmed coverage while Ms. Mahoney was working at the La Jolla facility. Based on the information obtained, there was insufficient evidence to corroborate the allegation of an administrator not being available. 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: 04/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2022

LIC9099 (FAS) - (06/04)

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