197608081-2-15-2022-31-AS-MVAO-CHLSJD-20220824135452

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608081
Report Date: 02/15/2022
Date Signed: 02/15/2022 02:54:09 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
02/09/2022 and conducted by Evaluator Michael Cava

COMPLAINT CONTROL NUMBER: 31-AS-20220209110608

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: 112	DATE:	02/15/2022
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	David Aguiniga		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility is out of ratio with hospice resident's
Unqualified Director operating facility
Resident's are being overmedicated

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Gary Tan and Michael Cava conducted a complaint visit to facility to investigate the above allegations. The day's investigation consisted of a physical plant inspection, record review, and held interviews with residents and staff.

During the course of the investigation, LPAs met and interveiwed with the operations manager, David Aguiniga. LPA's conducted a physical plant inspection from 9:35am to 10:30am, requested and reviewed facility documents at 10:30am, and conducted interviews from 10:45am to 1:00pm.

Facility is out of ratio with hospice residents:
In regards to the above allegation, a review of the facility license indicate that facility has a hospice waiver approved for 25. Mr. Aguiniga and staff conducted a count to confirm how many facility residents are receiving hospice care. Their count reveals 22 residents receiving hospice care. LPAs Tan and Cava

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: 02/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2022

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-20220209110608

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: 02/15/2022

NARRATIVE

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conducted a record review and verified there are 22 residents receiving hospice care. Based on interviews and record review, it could not be proven that facility is retaining more residents receiving hospice care than approved for. Therefore, the allegation is deemed Unsubstantiated at this time.

Unqualified Director operating facility:
In regards to the above allegation, it was reported that Carol Trejo is not a qualified administrator. LPAs Tan and Cava conducted a record review pertaining to Ms. Trejo. Review of the facility file indicate that Carolina Garcia-Trejo is listed as the facility administrator. Review of facility files further indicates that Ms. Trejo has been employed by the facility since July 2018. She was hired as a wellness director at that time. She was then placed as interim administrator in February 2021, then promoted to the position permanently in June 2021. LPAs obtained a copy of Ms. Trejo's certificate and it is effective from 12/7/20 through 4/23/22. Based on interviews and a review of staff and facility records, it could not be proven that there is an unqualified director in charge of facility operation. Therefore, the allegation is deemed Unsubstantiated at this time.

Resident's are being over-medicated:
In regards to the above allegation, it was reported that all residents are being drugged with psychotrophic drugs. The reporting party did not identify resident names. The investigation consisted of LPAs Tan and Cava interviewing residents and reviewing the facility's medication log. Interviews with residents do not corroborate with the allegation. Residents did not express any concerns regarding their medication management. LPAs did not observe any discrepancies while reviewing the facility's medication log. Based on interviews with residents and a review of and facility medication records, it could not be proven that residents are being over-medicated. 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: 02/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2022

LIC9099 (FAS) - (06/04)

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