197608081-7-3-2024-31-AS-NMAN-D9MR53-20241001124227

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608081
Report Date: 07/03/2024
Date Signed: 07/03/2024 04:13:34 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
05/23/2024 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20240523154103

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: 132	DATE:	07/03/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Carol Garcia-Trejo		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Resident's relocation was not reported to the required agencies

INVESTIGATION FINDINGS:

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At 9:00 a.m. on 07/03/24, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced, subsequent complaint visit. LPA met with the Exectuive Director (ED) and disclosed the reason for the visit.

Regarding the allegation “Resident's relocation was not reported to the required agencies”, it was alleged the facility did not report the relocation of R1 to R1’s case manager, and the facility did not report R2’s hospitalization and placement in a skilled nursing facility (SNF) to R2’s family member (F1).

To investigate the allegation, LPA conducted an initial visit on 05/29/24 and interviewed R1’s case manager at 10:30 a.m., Staff #1 (S1) at 2:30 p.m., a SNF staff (S2) at 2:55 p.m., and the ED at 4:15 p.m., reviewed records pertinent to the investigation including but not limited to incident reports, a medical assessment, and legal documents at 3:15 p.m., and toured the facility at 4:00 p.m. Today, LPA toured the facility at 10:00 a.m. and interviewed the ED at 11:30 a.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: 07/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2024

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-20240523154103

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: 07/03/2024

NARRATIVE

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Interview with R1's case manager revealed that the facility did in fact report R1's relocation. R1's case manager had no issue with facility reporting. Interview with F1 at 10:50 p.m. on 05/26/24 revealed they were also notified of R2's relocation. F1 had issue with the relocation itself as they claimed to be responsible for R2's medical decisions. Interview with the ED at 4:15 pm. on 05/29/24 confirmed the facility did in fact notify R1's case manager of R1's relocation and F1 of R2's relocation. The ED and S2 stated the legal document which F1 submitted to show authority over R2's medical decisions was expired. Record review of that legal document revealed it expired on 05/04/24. Record review of an incident report revealed R2 was admitted to Encino Hospital on 05/23/24 after consultation with a wound nurse determined R2 required medical attention. The incident report also noted F1 was notified of the relocation. Based on interviews and record reviews, the facility properly notified the proper individuals and agencies of resident relocations. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Exit interview conducted. 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: 07/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2024

LIC9099 (FAS) - (06/04)

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