197608081-11-14-2023-31-AS-NMAN-D3HQUB-20240319122827

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608081
Report Date: 11/14/2023
Date Signed: 11/14/2023 01:31:55 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
04/04/2023 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20230404135320

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: 130	DATE:	11/14/2023
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Carolina Garcia		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Licensee neglect resulted in resident sustaining unexplained injuries

INVESTIGATION FINDINGS:

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At 11:15 a.m. on 11/14/2023, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with the licensee and disclosed the reason for the visit. LPA and Staff #4 (S4) toured the facility at 1:00 p.m.

Regarding the allegation “Licensee neglect resulted in resident sustaining unexplained injuries” it was alleged Resident #1 (R1) suffered unexplained bruising on their chin, left elbow, and left ankle, as well as swelling in their left leg due to lack of care from the licensee.

To investigate the allegation, LPA toured the facility at both 1:15 p.m. on 04/13/2023 and at 9:45 a.m. on 09/12/2023, reviewed records at 10:40 a.m. on 4/13/2023 including but not limited to R1’s medical assessment, preplacement appraisal, care plan, incident report, and email correspondences, interviewed facility staff between 11:00 a.m. and 1:00 p.m. on 04/13/2023, and interviewed 10% of residents (13 out of 130 residents) between 9:30 a.m. and 4:00 p.m. on 09/12/2023.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 11/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2023

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-20230404135320

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: 11/14/2023

NARRATIVE

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Record review of R1’s Individual Service Plan revealed R1 “has poor judgement and needs monitoring for safety. Needs constant supervision” The Service Plan further noted that the facility was responsible for monitoring R1 for changes in condition, repositioning R1 frequently, transferring R1 with 2 staff members, and communicating with physician and family regularly. Email correspondences revealed facility staff observed and reported all injuries to the appropriate parties in a timely manner. Staff interviews revealed that although staff observed and reported the injuries, no staff witnessed or knew of the cause of the injuries. LPA interviewed Staff #1 (S1) at 11:30 a.m. on 04/13/2023, Staff #2 (S2) at 12:00 p.m. on 04/13/2023, and Staff #3 (S3) at 12:15 p.m. on 04/13/2023. S1 and S2 both noticed R1 was closer to their bed rails than usual after the elbow bruising. S2 and S3 stated R1’s facial injury was noticed after their dental appointment. S2 and S3 further noted that they always use 2 staff to transfer R1 as instructed in R1’s care plan, and R1 was monitored at least every 2 hours and daily for changes in condition. No staff observed other residents enter R1’s room. Residents interviewed stated they had not injured anyone nor witnessed any other residents be injured. Residents also mentioned that staff are quick to respond when a resident needs assistance. LPA’s attempts to interview R1 at 12:45 p.m. on 04/13/2023 and at 11:30 a.m. on 09/12/2023 did not yield any pertinent information. Based on record review and interviews, the licensee followed R1’s care plan, and there is not enough information to confirm the allegation is true. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

No immediate health or safety hazards were observed during the time of this visit.

Exit interview conducted. Appeal rights discussed. Copy of report provided.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 11/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2023

LIC9099 (FAS) - (06/04)

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