197608081-10-20-2021-31-AS-RRAZ-CPKU9T-20230303142338

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608081
Report Date: 10/20/2021
Date Signed: 10/20/2021 05:57:37 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
10/13/2021 and conducted by Evaluator Yelena Avetisyan

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: 104	DATE:	10/20/2021
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Carolina Garcia-Trejo		TIME COMPLETED:	06:00 PM

ALLEGATION(S):

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Smoke alarms are not working.
Staff working with hospice residents are not qualified.

INVESTIGATION FINDINGS:

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An unannounced subsequent complaint visit was conducted on this day by licensing program analyst (LPA) Yelena Avetisyan.

Regarding the allegation of Smoke alarms were not working it was reported that there was a small fire in the room of a resident in the memory care caused by a lamp, the smoke alarms did not go off when the fire was occurring. On 10/18/2021 LPA conducted a tour of the room indicated on the complaint and spoke with the current administrator. While touring the room LPA did not observe any smoke damage. According to Ms. Trejo the family of the resident brought a new lamp and did not completely remove the plastic. When the lamp was turned on it melted the plastic causing very little smoke. Per administrator the incident did not cause a fire and did not cause heavy smoke to be in the rooms and believes that is the reason the smoke alarms were not activated. On 10/20/2021 at 8:30 am LPA conducted telephone interview with LAFD Inspector regarding the allegation. According to the inspector the smoke detectors will not always activate when there is a small fire, it all depends on the amount/severity of the smoke in relation to where the smoke detectors are located.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Yelena Avetisyan	TELEPHONE: (818) 378-8120
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2021

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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: AVANTGARDE SENIOR LIVING OF TARZANA	FACILITY NUMBER: 197608081
	VISIT DATE: 10/20/2021

NARRATIVE

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During todays visit LPA conducted interview with the med-tech who was working when the incident occurred. According to the med-tech she was notified by a caregiver of a smoke smell in the memory care. Both staff entered the room indicated in the complaint and saw the plastic on the lamp was smoking. Med-Tech immediately removed the lamp ensured it was no longer smoking and placed it outside the facility. Both staff took the residents out of the room and opened the windows to clear the air. Med-Tech stated that there wasn't a fire and only a small amount of smoke, however there was a strong smoke smell. During this visit LPA along with the maintenance director tested the smoke detectors in memory care and confirmed that it was working properly.

Based on the information obtained the allegation is Unsubstantiated at this time.

Regarding allegation of : Staff working with hospice residents are not qualified it was reported that the facility staff are providing shower assistance to residents in place of the hospice agency staff. It was also reported that the licensee has hired a current facility staff to provide showers for the residents in place of the hospice staff.
On 10/18/2021 LPA conducted interview with the administrator who reported that the hospice agency listed in the complaint provides a staff who is at the facility Monday through Friday from 6:00 am to 2:00 pm. The hospice staff along with facility staff provide showers to the hospice residents. Additionally on 10/18/2021 at approximately 1:02 pm LPA conducted interview with Staff 1 (S1) who is the hospice agency staff. Per S1 she provides assistance to those residents who are receiving services from the agency she works for. S1 stated that there are other staff who come on Tuesdays, Wednesdays and Fridays. S1 stated that she is paid by the hospice agency and is a licensed CHHS. During this visit LPA obtained information that S1 also works for the facility as a med-tech on the days she is listed scheduled to work for the hospice agency. At 3:49 pm LPA re-interviewed S1 who confirmed working for the facility and the hospice agency. Staff also confirmed that she is paid from the hospice agency and the facility separately.

Based on the information obtained the allegation is Unsubstantiated at this time.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Yelena Avetisyan	TELEPHONE: (818) 378-8120
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2021

LIC9099 (FAS) - (06/04)

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