197608081-1-11-2023-31-AS-RRAZ-CPKU9S-20230303142337

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608081
Report Date: 01/11/2023
Date Signed: 01/11/2023 01:09:14 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
10/13/2021 and conducted by Evaluator Evelin Rios

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20211013141439

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: 116	DATE:	01/11/2023
		UNANNOUNCED	TIME BEGAN:	10:05 AM
MET WITH:	Carolina Terjo-Garcia		TIME COMPLETED:	01:20 PM

ALLEGATION(S):

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Financial Abuse

INVESTIGATION FINDINGS:

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An unannounced subsequent complaint visit was conducted on this day by Licensing Program Analyst (LPA) Evelin Rios. Upon arrival, LPA Rios met with Abigail Gigante the Administrator Assistant and Maria Juarez who assisted the LPA with the visit. The administrator Carolina Garcia-Trejo met us after.

Regarding the allegation of financial abuse; it was reported that prior facility administrator was terminated because she committed Financial Abuse/embezzlement while working at the facility. During the 10/18/2021 visit, LPA Avetisyan requested documentation and detailed information related to the complaint. On 10/19/2021 LPA received the incident report, SOC 341, and a brief explanation. On 10/20/2021 LPA Avetisyan requested further information on the timeline of events and recourse the facility took. On 08/09/2022 LPA Avetisyan requested a status on the police investigation and insurance company investigation. On 01/07/2023 LPA Rios reviewed documents received by LPA Avetisyan. These include but are not limited to insurance company acknowledgment of new claims and a police report made for the above allegation reported 07/20/2021. (LIC 9099 continued)

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: 01/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2023

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-20211013141439

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: 01/11/2023

NARRATIVE

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On 01/11/2023 from 10:14 a.m. to 10:46 a.m. LPA Rios obtained and reviewed copies of pertinent information for the investigation. From 10:46 a.m. to 11:45 a.m. LPA reviewed documents and records. From 12:00 p.m. to 12:30 p.m. LPA interviewed administrator Carolina. Carolina corroborated that the previous administrator was terminated due to multiple concerns one being embezzlement. Therefore, the allegation stating financial abuse; prior facility administrator was terminated because she committed Financial Abuse/embezzlement while working at the facility is Substantiated. Pursuant to Title 22 Division 6 of the CA Code of Regulations, a deficiency was cited (refer to LIC 809-D).

Exit interview conducted, Appeal Rights provided, and a copy of the report was issued.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Evelin Rios	TELEPHONE: 424-299-6104
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 31-AS-20211013141439

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: 01/11/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 01/12/2023 Section Cited CCR 87468.2(a)(8)	1 2 3 4 5 6 7	(a)...Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (8) To be free from neglect, financial exploitation...	1 2 3 4 5 6 7	Facility terminated the previous administrator and cleared overdue balances from residents identified to have been in collections by previous administrator's actions. No POC required at this time.
	8 9 10 11 12 13 14	Based on LPA's interviews and record review, the licensee failed to ensure that the resident’s personal rights were observed and respected by the previous administrator. This poses an immediate safety and personal rights risk to the resident in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: 01/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2023

LIC9099 (FAS) - (06/04)

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