197608081-12-23-2022-31-AS-MCAA-CMDRTK-20221223121827

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197608081
Report Date: 12/23/2022
Date Signed: 12/23/2022 12:18:33 PM

Document Has Been Signed on 12/23/2022 12:18 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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
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: 115	DATE:	12/23/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:14 AM
MET WITH:	Abigail Gigante		TIME COMPLETED:	12:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analysts (LPAs) Gary Tan and Michael Cava conducted an Annual Required visit and inspection of the facility. LPAs met with the assistant administrator, Abigail Gigante, and explained the reason for the visit. The facility is a two story building, that has a rooftop storage. The first and second floors are for resident occupancy. The third level/rooftop storage only used for storage for maintenance and emergency food supplies. It is not accessible to residents, and needs a key at the elevator to access. . At approximately 9:30am, with the assistance of the assistant administrator, LPAs took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms are hardwired. There are carbon monoxide detectors throughout the facility that functions properly. There are also fire extinguishers located in the hallways of the first and second floors. The charge date is October 12, 2022. Kitchen: The kitchen appliances and fixtures were functional. LPAs found a sufficient amount of perishable and non-perishable food properly stored in the refrigerator and freezer. Bedrooms: The facility has a total of 108 bedrooms that are combined shared or private. All private rooms are located on the first floor. LPAs observed bedrooms, for both private and shared, to be properly furnished with appropriate beddings and linens with sufficient lighting. Bathrooms: All resident bedrooms, private and shared, have their own bathroom. Bathrooms were properly supplied and had functional fixtures. Hot water temperature ranged between 111 to 119 degrees Fahrenheit. Common Areas: These included the tv/living room, located near the lobby at the front of the building, activity room and dining area. The facility also has a cafe located on the first floor. The common areas were properly furnished and clean. The auditory alarms in the memory care at the entrance and exit doors were on and functional at the time of the visit. You need a code to enter and exit the memory care unit.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 12/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 12/23/2022

NARRATIVE

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Surrounding Grounds: Entry/exits were free of obstruction. The outdoor area, front and back entrance were free of hazards. The laundry area is located on the second floor.

Resident Files: LPA conducted a file review of resident records to insure compliance of licensing forms.

Staff Files: LPA also conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms.

Medications: The medication room is located on the second floor. Medication and Medication Records were review for proper documentation. Medication room is locked at all times.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a Copy of this Report Issued.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 12/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2022

LIC809 (FAS) - (06/04)

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