197608081-2-21-2024-31-AS-NMAN-D8URHV-20240906130258

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608081
Report Date: 02/21/2024
Date Signed: 02/21/2024 03:45:46 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
01/10/2024 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20240110095826

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: 134	DATE:	02/21/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Carolina Garcia-Trejo		TIME COMPLETED:	03:50 PM

ALLEGATION(S):

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Staff did not seek timely medical attention for a resident

INVESTIGATION FINDINGS:

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At 9:00 a.m. on 02/21/24, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with the Executive Director (ED) and disclosed the reason for the visit.

To investigate the allegation above, LPA conducted an initial visit on 01/19/2024 and interviewed three (03) staff and one (01) hospice nurse between 9:50 a.m. and 11:00 a.m., obtained pertinent records at 10:45 a.m., and toured the facility at 10:30 a.m. Today, LPA interviewed the ED, six (06) staff members, and a doctor between 9:00 a.m. and 12:00 p.m., reviewed pertinent records at 2:00 p.m. including but not limited to an admission agreement, identification form, staff list, staff schedule, resident list, medication list, and care plan, and toured the facility at 3:00 p.m.

Regarding the allegation “Staff did not seek timely medical attention for a resident“ it was alleged staff did not call 9-1-1 when Resident #1 (R1) experienced a serious health condition.

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: 02/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2024

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-20240110095826

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: 02/21/2024

NARRATIVE

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After admission to the hospital. R1 was diagnosed with a pulmonary embolism. Interviews with five (05) out of six (06) staff members revealed that in the days leading up to the event, R1 had not reported any signs of labored breathing, shortness of breath, or other health-related conditions. R1 did report labored breathing to a family member (F1) on 01/09/2024. R1’s hospice nurse (H1) was called for an assessment. Interview with H1 at 11:00 a.m. on 01/19/2024 revealed R1 reported shortness of breath on the morning on 01/09/2024, but R1 had no visible signs of distress when H1 arrived. R1’s vital signs were taken and were normal. R1 reported no pain to H1 during the visit. H1 ordered additional medication for R1. F1 called 9-1-1 for R1 and R1 was taken to the hospital. Record review of R1’s care plan revealed facility staff and the hospice agency had followed all protocols outlined for R1. Based on interviews and record review, R1 did not report any sign of distress to staff, and R1’s vital signs were normal, indicating no medical attention was necessary. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

No immediate health and safety hazards 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: 02/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2024

LIC9099 (FAS) - (06/04)

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