197608081-9-22-2022-31-AS-EMIR-CKSMHG-20221102093731

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608081
Report Date: 09/22/2022
Date Signed: 09/22/2022 02:20:40 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
09/16/2022 and conducted by Evaluator Michael Cava

COMPLAINT CONTROL NUMBER: 31-AS-20220916121535

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: 106	DATE:	09/22/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Carol Garcia-Trejo		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff is threatening to drug resident
Facility did not safeguard resident's personal belongings

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Michael Cava conducted a complaint visit to the facility to investigate the above allegations. LPA met with the administrator, Carol Garcia-Trejo, and advised her of the visit. During the course of the investigation, LPA conducted an inspection of the physical plant to insure the health and safety of the clients, interviews and record review.

Staff is threatening to drug resident:
In regards to this complaint, it's being alleged that Resident 1 (R1) is being abused by a staff named "Roberta", who is threatening to use needles to "drug up" R1. Interviews with administrator and staff deny the allegation. Interviews with ten of ten residents also deny that they've been threatened by staff of getting drugged. According to administrator, there is no staff by the name of Roberta employed at this facility. A review of the staff schedule and Licensing Information System (LIS) profile confirms that there is no staff

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: 09/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022

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-20220916121535

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: 09/22/2022

NARRATIVE

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employed at the facility that go by that name. Further information from the administrator reveal that R1 has been refusing to take their medication. Review of the facility medication records confirm that R1 has been
refusing to take their medicine and their primary physician and Nurse Practitioner (NP)has been notified. Per administrator, R1 was told by the NP that if they continue to refuse medication, R1 would get placed on a 5150 hold. LPA made contact with R1's doctor office to verify this information and it was confirmed there. Based on the information obtained, there was insufficient evidence to corroborate the allegation of facility staff threatening to drug R1. Therefore, the allegation is deemed Unsubstantiated at this time.

Facility did not safeguard resident's personal belongings:
In regards to the allegation, it was reported that staff has been entering R1's room and taking R1's Styrofoam cups. Interviews with the administrator and staff deny the allegation. Interviews with ten of ten residents also expressed no complaints or concerns that facility is not safeguarding their belongings. According to the administrator, Law Enforcement was called by R1, and they responded to a complaint made by R1. When the officers appeared at the facility, they determined that the call wasn't a police matter and deemed it a mental health concern. The officers did not leave a report. Review of R1's records reveal that R1 has some confusion and disorientation. Furthermore, R1 did not complete an inventory list since being admitted. LPA reviewed R1's LIC 621 and it had no entries. Based on the information obtained, there was insufficient evidence to corroborate the allegation of facility not safeguarding R1's personal belongings. 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: 09/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022

LIC9099 (FAS) - (06/04)

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