197608081-7-27-2022-31-AS-EMIR-CKJN52-20221025100846

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608081
Report Date: 07/27/2022
Date Signed: 07/27/2022 01:03:40 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 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
07/21/2022 and conducted by Evaluator Evelin Rios

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20220721125636

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:	07/27/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Alberta Cedano		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff are not wearing masks in the facility.

INVESTIGATION FINDINGS:

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An unannounced initial 10 day complaint visit was conducted on this day by licensing program analysts (LPA’s) Evelin Rios and Yelena Avetisyan. Approximately 9:30 am upon LPA Rios’s arrival and entrance to the facility the LPA was not properly screened for COVID-19 precautions. LPA Rios were asked to conduct temperature check and Covid-19 screening for herself. LPA Avetisyan arrived to the facility at approximately 10:15 am was asked to conducted temperature check and Covid-19 screening for herself.

Upon arrival to the facility LPA Rios met with staff Maria Juarez, who contacted the administrator Carolina Garcia Trejo. Ms. Juarez informed the LPA that administrator would not be able to come to the facility at this time.

In regards to the allegation it was reported that the staff are not wearing masks while working or are wearing masks inappropriately. Approximately 9:30 am upon entering the facility LPA Rios observed Staff 1 (S1) at reception wearing a mask inappropriately under their nose.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Evelin Rios	TELEPHONE: 424-299-6104
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2022

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-20220721125636

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: AVANTGARDE SENIOR LIVING OF TARZANA	FACILITY NUMBER: 197608081
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/27/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/27/2022 Section Cited CCR 87468.1(a)(2)	1 2 3 4 5 6 7	87468.1 Personal Rights of Residents in All Facilities(a)...(2) To be accorded safe, healthful... accommodations, furnishings and equipment. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee/Administrator and all staff will attend infection control training to be provided by an individual trained/certified in infection control. Administrator will designate staff to screen all visitors for Covid-19 upon arrival. Licensee/administrator will submit the credentials of the trainer with the
	8 9 10 11 12 13 14	Based on observations made during the complaint investigation visit the staff did not comply with the section cited above by not wearing face mask/covering while working in the facility which poses a potential health, safety and personal rights risk to residents in care.	8 9 10 11 12 13 14	scheduled training dates by 7/28/2022 and completion of training by 8/12/2022. Additionally administrator will submit a signed dated written statement notifying the department what steps will be taken to ensure staff are wearing masks appropriately at all times while working.
Type A 07/27/2022 Section Cited CCR 87470(c)(1)	1 2 3 4 5 6 7	87470(c) Infection Control Requirements shall be developed by the licensee... (1) The Infection Control Plan shall include: (F) Staff shall demonstrate knowledge... appropriate to the job assigned and as evidenced by safe and effective job performance.	1 2 3 4 5 6 7	Licensee/Administrator and all staff will attend infection control training to be provided by an individual trained/certified in infection control. Administrator will designate staff to screen all visitors for Covid-19 upon arrival. Licensee/administrator will submit the credentials of the trainer with the
	8 9 10 11 12 13 14	Based on observations made the licensee/administrator did not comply with the cited section by not ensuring staff are following infection control Requirements which poses an immediate Health and Safety and personal rights risk to persons in care.	8 9 10 11 12 13 14	scheduled training dates by 7/28/2022 and completion of training by 8/12/2022. Additionally administrator will submit a signed dated written statement notifying the department what steps will be taken to ensure staff are wearing masks appropriately at all times while working.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Evelin Rios	TELEPHONE: 424-299-6104
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2022

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20220721125636

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: AVANTGARDE SENIOR LIVING OF TARZANA	FACILITY NUMBER: 197608081
	VISIT DATE: 07/27/2022

NARRATIVE

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Approximately 10 am LPA Rios conducted a tour of the facility including memory care with staff Alberta Cedano Care Coordinator. Upon entering the memory care LPA Rios observed a Staff 2 (S2) wearing a mask inappropriately under their nose. LPA also observed S2 touch their nose and proceeded to put the mask over their nose and continue working without washing/sanitizing their hand.

Approximately 10:30 am LPA Rios and Avetisyan conducted a subsequent unassisted tour. Upon entrance to the kitchen LPA’s observed Staff 3 (S3) without a mask, LPA’s then continued walking in the kitchen and observed Staff 4 (S4) with their mask hanging on their ear. LPA’s requested for staff to put on their masks. As LPA’s were walking out of the kitchen they observed S4 wearing a mask inappropriately under their nose. Approximately 11:11 am LPA Avetisyan conducted a telephone interview/discussion with the administrator regarding the complaint investigation, screening protocols and reporting requirement.

The LPA's observation support the allegation of staff are not wearing masks therefore the allegation is Substantiated at this time.
Per the California Code of Regulations, Title 22, Division 6, Chapter 8, the following deficiencies were observed and cited during the visit (See 9099-D). Exit interview conducted. A copy of the report was provided.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Evelin Rios	TELEPHONE: 424-299-6104
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2022

LIC9099 (FAS) - (06/04)

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