197608081-11-29-2023-31-AS-EMIR-D74R7P-20240712124641

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608081
Report Date: 07/03/2023
Date Signed: 11/29/2023 04:04:35 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 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
06/15/2023 and conducted by Evaluator Mariana Agban

COMPLAINT CONTROL NUMBER: 31-AS-20230615153708

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: 136	DATE:	07/03/2023
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Carolina Trejo, Administrator		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff refused to admit resident back to facility
Staff is withholding residents personal belonging

INVESTIGATION FINDINGS:

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On 07/3/2023 at 10:30 Am Licensing Program Analyst (LPA) Mariana Agban arrived at the facility to conduct an unannounced subsequent complaint investigation. Upon arrival, LPA was greeted by the administrator, and the purpose of the visit was explained. Between 12:00- 1:00 PM, LPA interviewed eight (8) more residents. LPA conducted interviews with the Administrator at 1:15 PM, with witness(es) and eight (8) of 136 residents and two (2) of four (4) of front desk staff. A review of facility files and/or document was conducted at approximately at 2:00 PM including but not limited the resident file for Resident #1 (R-1).

Allegation 1#: Staff refused to admit resident back to the facility

The complainant advised that the facility didn't admit R-1 back to the facility. The Administrator denied the allegation. The information obtained during records reviews and interviews indicated that R-1 self admitted to the Skilled Nursing Facility (SNF) in November of 2022 without providing the required notice to the facility. (LIC 9099 Continued)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Mariana Agban	TELEPHONE: 818-738-4525
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2023

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-20230615153708

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: AVANTGARDE SENIOR LIVING OF TARZANA	FACILITY NUMBER: 197608081
	VISIT DATE: 07/03/2023

NARRATIVE

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R-1 ceased to pay rent at that time and departed with R-1’s personal belongings. There is no evidence that R-1 requested re-admission subsequent to leaving in November of 2022.

Allegation: Staff is withholding residents' personal belongings

The complainant advised that the facility withheld the personal belongings of Resident #1. Based on interview with the administrator and Resident Personal Property and Valuables (LIC621), R1's belongings were picked up on 11/07/2022. In addition, S1 and S2 have confirmed that the facility's front desk hasn't got any phone calls from R1. Moreover, S1 was a witness when R1's belongings were picked up. S1 and S2 denied the above allegation.

There's insufficient evidence to either confirm the above allegations. The allegations are deemed UNSUBSTANTIATED. Copy of the report provided and exit interview conducted

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Mariana Agban	TELEPHONE: 818-738-4525
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2023

LIC9099 (FAS) - (06/04)

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