197608081-4-11-2024-31-AS-NMAN-D4TVCF-20240430161903

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608081
Report Date: 04/11/2024
Date Signed: 04/11/2024 02:54:45 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
04/10/2024 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20240410102121

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: 137	DATE:	04/11/2024
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Carolina Garcia-Trejo		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff won't accept resident back into faciltiy

INVESTIGATION FINDINGS:

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At 11:30 a.m. on 04/11/2024, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced, subsequent complaint visit. LPA met with the Executive Director (ED) and disclosed the reason for the visit.

Regarding the allegation “Staff won't accept resident back into facility” it was alleged the facility would not readmit Resident #1 (R1). To investigate the allegation, LPA conducted an initial visit on 04/10/2024 and toured the facility at 3:15 p.m., conducted a records review at 3:30 p.m., and interviewed R1 at 3:35 p.m., Staff #1 (S1) at 3:50 p.m., and Staff #2 (S2) at 4:00 p.m. Today, LPA toured the facility at 11:40 a.m., conducted another records review of pertinent records including but not limited to the resident list, an admission agreement, care plan, medical assessment, incident report, and discharge paperwork, and interviewed Staff #3 (S3) at 11:50 a.m., the ED at 12:00 p.m., a family member (F1) at 12:30 p.m., a case worker at 1:00 p.m., and the hospital discharge planner at 1:15 p.m.

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: 04/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024

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-20240410102121

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: 04/11/2024

NARRATIVE

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Interview with the ED and review of an incident report revealed R1 was admitted to the hospital on 04/05/2024 due to a fall. Interview with F1 revealed R1 was ready to be readmitted to the facility on 04/07/2024 but the facility refused to accept R1 back. Interviews with the ED, case worker and hospital discharge planner revealed the facility would not readmit R1 due to their unstageable pressure injury. The ED stated they arranged for two (02) different skilled nursing facilities to admit R1 so their unstageable pressure injury could heal. The ED also received medical advice supporting the skilled nursing admission from R1’s primary care physician. The ED stated that the doctor and nurses at the hospital did not find R1 suitable for admission to a skilled nursing facility and insisted R1 return to Avantgarde Senior Living of Tarzana. Review of discharge paperwork revealed R1 was admitted for “generalized weakness” and diagnosed with a “right lateral heel unstageable pressure ulcer 1x1x0 centimeters 100% eschar”. Mayo Clinic defines “eschar” as “dead tissue that eventually sloughs off healthy skin after an injury”. The hospital discharge planner clarified that the right heel pressure ulcer was “lower than a level one pressure injury”, but the nurses would not peel back the scab to measure the wound to allow it to heal. The hospital discharge planner further clarified that all wounds with healing scabs are deemed unstageable regardless of their depth, and the ED did contact the hospital for a measurement. Interview with the ED and review of the facility attendance record revealed R1 was readmitted on 04/09/2024 at 4:48 p.m. Based on interviews and record review, the facility complied with Title 22 regulations by refusing to readmit R1 due to their unstageable pressure injury. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

No immediate health and safety risks were observed during 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: 04/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024

LIC9099 (FAS) - (06/04)

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