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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608081
Report Date: 03/03/2022
Date Signed: 03/03/2022 02:45:36 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 TARZANAFACILITY NUMBER:
197608081
ADMINISTRATOR:CAROLINA GARCIA-TREJOFACILITY TYPE:
740
ADDRESS:5645 LINDLEY AVENUETELEPHONE:
(818) 881-0055
CITY:TARZANASTATE: CAZIP CODE:
91356
CAPACITY:138CENSUS: 111DATE:
03/03/2022
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Carolina Garcia-TrejoTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Unqualified staff assessing resident's care
Unqualifeid staff signing off on resident's documents
Resident's care is not being assessed for a higher level of care
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 interviews with residents and staff.

During the course of the investigation, LPAs met and interveiwed with the administrator, Carolina Garcia-Trejo. LPA's conducted a physical plant inspection at 9:02am, requested and reviewed facility documents at 9:35am, and conducted interviews from 10:00am to 12:45pm.

Unqualified staff assessing resident's care/Unqualified staff signing off on resident's documents:
In regards to the above allegations, it's alleged that Staff 1 and 2 (S1 & S2) are assessing for resident's care, signing prescription forms that are sent to the pharmacy, and placing residents on hospice care, even if the residents do not qualifiy. S1, admits she is not a nurse. Her job title is care coordinator.

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael CavaTELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
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: 03/03/2022
NARRATIVE
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Her duties include scheduling and supervising caregivers. S1 denies assessing for resident's care, signing prescription forms that are sent to the pharmacy, and placing residents on hospice care, even if the residents do not qualify. S1 states only the administrator, who is a licensed nurse does the assessment and reassessment for the residents to insure their needs are being met. S1 states she doesn't sign any refill prescription forms. Resident medications are bubble pack. It gets refilled automatically every 28 days. For prescription medicine that are as needed or in a bottle, either her or another medication staff would call the pharmacy within five days of the prescription medication running out to request a refill. S2, who works for marketing also states she is not a nurse. Some of her duties include processing admission paper work, marketing, and sometimes assist with medications as she previously held the position of a med tech. S2 also denies assessing for resident's care, signing prescription forms that are sent to the pharmacy, and placing residents on hospice care, even if the residents do not qualify. S2 states she may go with the administrator to assist her with resident paperwork, but doesn't do any of the assessments. According to the administrator, she primarily does the pre-assessment/appraisal of the resident prior to admission. She determines them for appropriateness and compatibility. In regards to signing off on documents for hospice care, the administrator denies doing so. She states she is in communication with hospice agency constantly to insure the resident needs are being met. Based on the information obtained it could not be proven that unqualified staff are assessing resident's care or signing off on resident's documents. Therefore, the allegation is deemed Unsubstantiated at this time.

Resident's care is not being assessed for a higher level of care:
In regards to the allegation it's being alleged that there are dementia residents and residents with severe psychiatric issues that shouldn’t be in assisted living. Reporting Party (RP) alleges that unqualified staff has been signing all forms that are sent to the pharmacy. RP stated that residents are being placed on hospice that don’t even qualify for it because they get a kick back. RP stated that there are 35 residents on hospice and that staff are signing off on that paperwork and not the doctor. Interviews with the administrator and staff reveal that they deny placing residents on hospice or signing off on their paperwork to receive kick backs. Staff stated that only the resident doctors makes the referral of residents to the hospice agency of their choice. The administrator states that she is constantly in communication with the resident's doctor and the hospice agency to insure the resident needs are being met. Currently the facility has 24 residents that are receiving hospice care. The administrator, who also holds an LVN license, stated she primarily does the pre-assessment/appraisal of the resident prior to admission. She determines them for appropriateness and compatibility. Review of records reveal that the facility utilizes three different hospice agencies.
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael CavaTELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
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: 03/03/2022
NARRATIVE
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Regarding unqualified staff signing all forms that are sent to the pharmacy, both the administrator and staff indicate that medications are bubble pack and refilled automatically every 28 days. For PRN or bottled medication, the med tech would call the pharmacy 5 days prior to the medication running out to request for a refill. Staff confirms that only the doctor signs off on the resident's prescriptions and refills. Based on the information obtained it could not be proven that resident's care is not being assessed for a higher level of care. Therefore, the allegation is deemed Unsubstantiated at this time.
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael CavaTELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3