197608081-9-12-2023-31-AS-NMAN-D3HTYC-20240319150831

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608081
Report Date: 09/12/2023
Date Signed: 09/12/2023 05:34:16 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
09/11/2023 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20230911115014

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: 127	DATE:	09/12/2023
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Joyce Martinez		TIME COMPLETED:	05:35 PM

ALLEGATION(S):

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Resident sustained a fracture due to staff neglect
Staff handled resident in a rough manner causing bruises
Residents sustained unexplained injuries due to neglect
Staff are inappropriately medicating residents
Staff is forcefeeding resident

INVESTIGATION FINDINGS:

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At 9:30 a.m. on 09/12/2023, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with Staff #1 (S1) and later the Director and disclosed the reason for the visit.

LPA interviewed staff and residents between 9:35 a.m. and 3:00 p.m. today, reviewed records at 3:00 p.m., and toured the facility at 9:45 a.m. and 4:30 p.m. No immediate health and safety risks were observed.

Regarding the allegation “Resident sustained a fracture due to staff neglect” it was alleged Resident #1 (R1) fractured their wrist due to neglect. Interview with S1 today at 2:40 p.m. today revealed R1 reported elbow pain at approximately 9:30 a.m. on 09/09/2023. S1 reported the incident properly thereafter.

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: 09/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 31-AS-20230911115014

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: 09/12/2023

NARRATIVE

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Record review at 3:00 p.m. today revealed R1 was taken to the hospital where it was discovered that R1 broke a bone in their elbow. R1’s care plan stated staff were to check on R1 every two hours. A supervision log revealed R1 was checked last at 9:00 a.m. on 09/09/2023. Therefore, the facility properly attended to and supervised R1. Based on interviews and record review, there is insufficient evidence to confirm the validity of the allegation. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation “Staff handled resident in a rough manner causing bruises” it was alleged Staff #2 (S2) caused bruising on the hand of Resident #2 (R2) after squeezing too hard. LPA observed R2’s hand today at 2:15 p.m. today and observed no bruising or discoloration. Interview with R2 today at 2:15 p.m. revealed R2 was not in pain and S2 did not squeeze too hard during the alleged incident. Interviews with other residents between 10:00 a.m. and 2:25 p.m. today revealed staff do not handle residents roughy. Interview with S2 at 1:25 p.m. and Staff #3 (S3) at 2:00 p.m. today revealed R2 often punched S2, S3, and other staff members. Based on interviews and observations, there is insufficient evidence to confirm the validity of the allegation. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation “Residents sustained unexplained injuries due to neglect” it was alleged Resident #3 (R3) had unexplained bruising on their legs. Observations at 4:30 p.m. today revealed R3 had no bruising or discoloration on their legs. Interviews with residents between 10:00 a.m. and 2:25 p.m. today revealed no residents had unexplained injuries. Interview with S2 at 1:25 p.m. and S3 at 2:00 p.m. today revealed staff performed daily body checks for R3 and did not observe any bruising or discoloration. Record review at 3:00 p.m. today revealed R3 fell at the facility and was properly assisted by staff afterwards. Based on interviews, record review, and observations, there is insufficient evidence to confirm the validity of the allegation. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation “Staff are inappropriately medicating residents”, it was alleged residents were provided medication to make them sleepy. Resident interviews between 10:00 a.m. and 2:25 p.m. today revealed no residents took or were provided medication which was not prescribed. Staff interviews between 9:35 a.m. and 2:40 p.m. today revealed physician orders were followed when assisting residents with medication. Record review today at 3:00 p.m. confirmed staff followed physicians orders when assisting with medications. No additional medication was provided to make residents sleepy. During observations of the medication room at 2:40 p.m., LPA observed medication matched physician’s orders and medication lists.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 31-AS-20230911115014

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: 09/12/2023

NARRATIVE

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Based on interviews, record review, and observations, there is insufficient evidence to confirm the validity of the allegation. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation “Staff is force feeding resident” it was alleged Resident #4 (R4) was fed too fast and choked. Attempted interview with R4 today at 11:25 a.m. did not reveal any information. Interviews with S2 at 1:25 p.m. and S3 at 2:00 p.m. today revealed staff are trained on proper feeding techniques. S2 recalled approximately 3 weeks ago, R4 choked during lunch. S2 assisted with removing the food and reassessed R4 for any further pain. LPA observed staff feeding residents during lunch today between 11:30 a.m and 12:15 p.m. and noticed proper feeding techniques applied. Based on interviews and observations, there is insufficient evidence to confirm the validity of the allegation. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

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: 09/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2023

LIC9099 (FAS) - (06/04)

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