197608081-12-27-2024-31-AS-NMAN-DFER58-20250404124244

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608081
Report Date: 12/27/2024
Date Signed: 12/27/2024 03:19:51 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
12/06/2024 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20241206100635

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: 122	DATE:	12/27/2024
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Joyce Martinez		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Resident sustained injury from a fall due to lack of supervision
Resident did not receive timely medical attention

INVESTIGATION FINDINGS:

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At 1:00 p.m. on 12/27/24 Licensing Program Analysts (LPAs) Nicholas Reed and Nadia Shahbazian conducted an unannounced subsequent complaint visit. LPAs met with the Marketing Director and disclosed the reason for the visit.

To investigate the allegations above, LPAs conducted an initial visit on 12/06/24 and interviewed the administrator at 3:10 p.m. and Staff #1 (S1) at 3:20 p.m. and toured the facility inside and out at 3:50 p.m. LPAs conducted a subsequent visit on 12/13/24 and conducted a record review of pertinent records, including but not limited to an admission agreement, medical assessment, care plan, supervision logs, and staff and client rosters at 1:00 p.m., interviewed staff between 1:30 p.m. and 4:00 p.m., and toured the facility inside and out at 1:30 p.m. Today, LPAs toured the facility at 1:00 p.m. and interviewed Staff #2 (S2) at 2:00 p.m. and Staff #3 (S3) at 2:20 p.m.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 12/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2024

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-20241206100635

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: AVANTGARDE SENIOR LIVING OF TARZANA	FACILITY NUMBER: 197608081
	VISIT DATE: 12/27/2024

NARRATIVE

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Regarding the allegation "Resident sustained injury from a fall due to lack of supervision" it was alleged the facility did not prevent Resident #1 (R1) from falling due to insufficient supervision. Record review of resident supervision logs revealed staff had checked on R1 every two (02) hours prior to their fall. R1’s care plan indicated that “staff will have fall precautions in place” and “staff are to document resident’s 2 hour checks”. Interview with S3 revealed they were the first to see R1 on the floor. R1 had fallen out of bed around 4:30 a.m. on 12/01/24. S3 noted R1 was alert and oriented. S3 called Staff #4 (S4) to assess R1 for injury. Interview with S4 at 4:00 p.m. on 12/13/24 revealed R1 did not have pain and did not want medical assistance. S4 reported the fall to R1’s representative and physician. Interviews with the administrator and staff revealed that R1 has had half bed rails in place as a fall precaution. Based on interviews and record review, facility staff provided sufficient supervision to R1. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation “Resident did not receive timely medical attention” it was alleged the facility did not provide or seek proper care for R1 after their fall. Interview with S4 revealed R1 refused medical attention after their fall. Interview with S3 revealed they notified R1’s home health agency of their fall on 12/01/24. Interview with S1 revealed they scheduled home health to assist R1 on 12/01/24. Record review indicated that R1’s home health agency visited on 11/30/24, 12/03/24, and 12/10/24. R1 showed no signs of distress during the visits. X-rays were performed on 12/03/24 and revealed R1 sustained no fractures or broken bones. S1 also noted that R1 reported not having any pain after the fall. R1 had no bruising until “several hours after” their fall. Based on interviews and record review, the facility offered immediate medical attention in a timely manner which R1 refused. Facility staff ordered follow-up medical attention in a timely manner as well. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Exit interview conducted. Copy of report provided.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 12/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2024

LIC9099 (FAS) - (06/04)

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