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Department of
SOCIAL SERVICES
Community Care Licensing
COMPLAINT INVESTIGATION REPORT
Facility Number:
197608081
Report Date:
06/07/2021
Date Signed:
06/07/2021 03:23:20 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
06/02/2021
and conducted by Evaluator
Wendell Smith
COMPLAINT CONTROL NUMBER:
31-AS-20210602111359
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:
107
DATE:
06/07/2021
UNANNOUNCED
TIME BEGAN:
11:45 AM
MET WITH:
Erin Mahoney
TIME COMPLETED:
02:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident was physically assaulted resulting in injury.
Staff did not care for resident's injury.
Staff over medicating resident.
Staff not allowing resident access to medication records.
Staff did not safeguard resident's personal belongings.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Wendell Smith conducted an initial complaint visit to investigate the allegations above. LPA met with the administrator and explained the reason for this visit.
Resident was physically assaulted resulting in injury.
It is alleged that resident # 1 (R1) was physically assaulted resulting in injury. LPA interviewed R1 and the administrator regarding this incident. Information revealed that R1 was not physically assaulted by anyone in the facility and R1 refused to say that they were assaulted or if anyone in the facility assaulted them. LPA reviewed R1's facility file and obtained copies of pertinent information. Based on the information obtained through interviews and record review this allegation is deemed Unsubstantiated at this time.
Staff did not care for resident's injury.
It is alleged that staff did not care for R1's injury. LPA interviewed R1 regarding this allegation. R1 stated that staff did treat their injury and that they have always gotten good care at the facility.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME:
Cassandra Harris
TELEPHONE:
(818) 596-4342
LICENSING EVALUATOR NAME:
Wendell Smith
TELEPHONE:
(818) 738-4525
LICENSING EVALUATOR SIGNATURE:
DATE:
06/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/07/2021
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
2
Control Number
31-AS-20210602111359
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:
06/07/2021
NARRATIVE
1
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9
10
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27
28
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31
32
Based upon the information obtained through interview this allegation is deemed Unsubstantiated at this time.
Staff over medicating resident.
It is alleged that R1 is being over medicated. LPA conducted interviews with R1 and the administrator. LPA also reviewed R1's medication documentation and obtained copies of pertinent information. Information from interviews and record review reveal that R1 is being given medication based on their physician order and that R1 has not been over medicated. R1 stated that they get their proper dosage of medication. Based on information obtained through interviews and record review this allegation is deemed Unsubstantiated at this time.
Staff not allowing resident access to medication records.
It is alleged that staff is not allowing R1 to see their medication records. LPA conducted an interview with R1 and the administrator regarding this allegation. R1 stated that they have been given access to their medication records and that this has not been an issue but they feel everyone they ask should be able to get it to her. Based on the information obtained through interview this allegation is deemed Unsubstantiated at this time.
Staff did not safeguard resident's personal belongings.
It is alleged that R1 has had their clothes and money stolen from their room. LPA conducted interviews with R1 and facility staff regarding the allegation. LPA reviewed facility documentation related to this allegation. Based on the interviews conducted this allegation is deemed Unsubstantiated at this time.
Exit Interview conducted. Copy of report will be emailed.
SUPERVISOR'S NAME:
Cassandra Harris
TELEPHONE:
(818) 596-4342
LICENSING EVALUATOR NAME:
Wendell Smith
TELEPHONE:
(818) 738-4525
LICENSING EVALUATOR SIGNATURE:
DATE:
06/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/07/2021
LIC9099
(FAS) - (06/04)
Page:
2
of
2