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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608081
Report Date: 08/24/2021
Date Signed: 08/24/2021 03:06:50 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
08/16/2021 and conducted by Evaluator Wendell Smith
COMPLAINT CONTROL NUMBER: 31-AS-20210816082350
FACILITY NAME:AVANTGARDE SENIOR LIVING OF TARZANAFACILITY NUMBER:
197608081
ADMINISTRATOR:ERIN MAHONEYFACILITY TYPE:
740
ADDRESS:5645 LINDLEY AVENUETELEPHONE:
(818) 881-0055
CITY:TARZANASTATE: CAZIP CODE:
91356
CAPACITY:138CENSUS: 115DATE:
08/24/2021
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Carolina TrejoTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Residents are not able to communicate with staff.
Facility phone doesn’t get answered because of not enough staff.
Resident not being provided adequate service.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Wendell Smith made an unannounced subsequent visit to finish investigation into the allegations above. LPA met with facility staff and explained the reason for this visit.
LPA conducted an initial visit to this facility on 8/17/21.

Residents are not able to communicate with staff
It is alleged that residents are not able to communicate with staff due to staff not speaking english. LPA conducted interviews from approximately 10am-11:30am with various residents regarding this allegation. Information from interviews reveal that residents are able to communicate sufficiently with facility staff. LPA also spoke with various staff throughout the visit and was able to communicate with staff in English. Based on the information obtained through interviews and observation this allegation is deemed Unsubstantiated at this time.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Wendell SmithTELEPHONE: (818) 738-4525
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021
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 2
Control Number 31-AS-20210816082350
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: AVANTGARDE SENIOR LIVING OF TARZANA
FACILITY NUMBER: 197608081
VISIT DATE: 08/24/2021
NARRATIVE
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Facility phone doesn’t get answered because of not enough staff.
It is alleged that the front desk does not answer the telephone in a timely manner. LPA conducted interviews with residents from 10am-11:30 am. Interviews revealed that residents have not had an issue when calling the front desk for assistance. Based on the information obtained through interviews and observation this allegation is deemed Unsubstantiated at this time.

Resident not being provided adequate service.
It is alleged that residents are not being provided baths due to a lack of staff and that the food service is lacking because of staff. LPA conducted a physical plant walk through and conducted interviews with residents from 10-11:30pm. LPA also observed lunch being served in the memory care unit at 11am. From 11:30am-12pm LPA observed lunch being served in the assisted living side of the facility. Based on the interviews conducted and what was observed during this visit this allegation is deemed Unsubstantiated at this time.
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Wendell SmithTELEPHONE: (818) 738-4525
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2