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Department of
SOCIAL SERVICES
Community Care Licensing
COMPLAINT INVESTIGATION REPORT
Facility Number:
197608081
Report Date:
08/02/2021
Date Signed:
08/02/2021 02:53:45 PM
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
07/30/2021
and conducted by Evaluator
Wendell Smith
COMPLAINT CONTROL NUMBER:
31-AS-20210730150302
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:
DATE:
08/02/2021
UNANNOUNCED
TIME BEGAN:
12:15 PM
MET WITH:
Carolina Garcia'Trejo
TIME COMPLETED:
01:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility failed to report Covid Cases
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced complaint visit. LPA met with the administrator and explained the reason for this visit.
Regarding the allegation above it is alleged that facility failed to report they had active covid cases. At approximately 12:30 pm LPA conducted an interview with the administrator regarding this allegation. Administrator stated that they did covid testing on 7/27/21 and on 7/30/21 late in the afternoon the results came back that one resident and one staff were positive. They then called Department of Public Health and notified them of the situation. Facility then conducted mandatory covid testing for all residents and staff from 4pm-8pm on 7/30/21. They received the results today and all were negative including the two that were initially positive. LPA received an incident report regarding the covid cases this morning at 9:28 am. Based on the information obtained through interviews and documentation received this allegation is deemed Unsubstantiated at this time. Facility did report the positive covid cases in a timely manner. Exit Interview conducted.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME:
Cassandra Harris
TELEPHONE:
(818) 596-4342
LICENSING EVALUATOR NAME:
Wendell Smith
TELEPHONE:
(818) 738-4525
LICENSING EVALUATOR SIGNATURE:
DATE:
08/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/02/2021
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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