197608081-1-4-2023-31-AS-MVAO-CN7U2D-20230118141145

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608081
Report Date: 01/04/2023
Date Signed: 01/04/2023 11:48:01 AM

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
12/28/2022 and conducted by Evaluator Michael Cava

COMPLAINT CONTROL NUMBER: 31-AS-20221228115253

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:	01/04/2023
		UNANNOUNCED	TIME BEGAN:	09:14 AM
MET WITH:	Abigail Gigante		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Facility staff not providing adequate supervision.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Michael Cava conducted a 10 day complaint visit to the facility to investigate the above allegation. On or around 12/27/22, it was reported that Resident 1 (R1) has hit Resident 2 (R2) several times. R2 did not provide details, but only one date, which was June 2021. No other recent dates were provided. No witnesses were identified. A full body assessment was made for R2, but no visible bruising was observed. Facility staff were aware of the incident, and offerred to seperate both residents, but R2 declined to do so. R1 and R2 are husband and wife. LPA met with the assistant administrator, Abigail Gigante, and advised her of the complaint. During the course of the investigation, interviews, record review and physical plant inspections were made.

At approximately 9:30am to 11:00am, interviews conducted with staff and residents. Per interviews with staff, they are not aware of R1 being physically aggressive towards R2, as it was never brought up to their attention. Staff is aware of R1 being verbally aggressive towards R2. Staff informed the LPA

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: 01/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2023

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-20221228115253

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: 01/04/2023

NARRATIVE

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that they have tried to offer R2 a separate room to avoid getting yelled at from R1, but R2 has declined to do so multiple times. Staff further stated that one of the reasons that R1 elevates their voice towards R2 is because R2 is hard of hearing. LPA is unable to interview R1 at this time as R1 is out for rehabilitation. Return date has yet to be determined. Attempts to interview R2 does confirm that R2 is hard of hearing. R2 does deny the allegation of staff failing to provide adequate supervision and confirms they declined to move to another room. Neighboring residents that reside near or next to R1 and R2 had no concerns regarding the two as they've never witnessed or observed R1 ever being aggressive to R2. The resident's responsible party was made aware of R1 elevating their voice towards R2. Plans have yet to be made to determine if both should be separated.

A review of R1's records do not indicate any confusion, disorientation, or aggressive behaviors. Although there are some cognitive impairment noted, R1 is able to follow instructions. There were no notes or record documented to indicate that either R1 or R2 have non-compliance issues with the house rules (not getting along with one another and/or others).

Based on the information obtained, there was insufficient evidence to corroborate the allegation of facility staff not providing adequate supervision. 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: 01/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2023

LIC9099 (FAS) - (06/04)

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