197608081-8-2-2024-31-AS-NMAN-DAAUPH-20241022154531

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608081
Report Date: 08/02/2024
Date Signed: 08/02/2024 04:43:27 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
06/26/2024 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20240626160719

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: 135	DATE:	08/02/2024
		UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Joyce Martinez		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Unlawful eviction

INVESTIGATION FINDINGS:

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At 1:10 p.m. on 08/01/24, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced, subsequent complaint visit. LPA met with the Marketing Director and disclosed the reason for the visit.
To investigate the allegations above, LPA conducted an initial visit on 07/03/24 and interviewed Resident #1 (R1) over the phone at 9:05 a.m., Staff #1 (S1) at 9:20 a.m., the administrator at 11:30 a.m., and Staff #2 (S2) at 3:00 p.m., reviewed records pertinent to the investigation including but not limited to an admission agreement, physician’s report, incident reports, and service plan at 10:00 a.m., and toured the facility at 10:30 a.m. LPA conducted additional interviews on 07/10/24 with R1’s case coordinator at 10:45 a.m. and a Skilled Nursing Facility (SNF) social worker at 11:15 a.m. Today, LPA interviewed Staff #3 at 1:30 a.m. and Staff #4 (S4) at 1:45 p.m.

Regarding the allegation “Unlawful eviction” it was alleged the facility did not allow R1 to return to the facility from the SNF.

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: 08/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2024

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-20240626160719

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: 08/02/2024

NARRATIVE

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Interview with the administrator revealed they never issued an eviction notice to R1 nor did they tell R1 they could not return. R1 was noncompliant with medical advice from their physician, so the facility and R1’s physician recommended to R1, R1’s family, and R1’s case coordinator that the facility may not be suitable for R1. Interview with S1 revealed R1 often had desserts and snacks high in sugar against medical and caregiver advice. Interview with S3 confirmed that R1 was not compliant with medical advice and was eventually admitted to the hospital due to a skin infection. Record review of R1’s physician’s report revealed R1 had a diagnosis of diabetes and a history of skin breakdown. An incident report from 05/09/23 confirmed R1 was sent to the hospital due to an infection of their amputated leg. Interview with R1 confirmed they never received an eviction notice. R1 stated that the SNF social worker told R1 they would move to a different assisted living facility upon discharge. Interview with the case coordinator and social worker revealed R1 was provided placement at an alternate facility based on the recommendation of the social worker. Although R1 was not consulted on the placement at a different facility, R1 was never evicted. Based on interviews and record review, the facility did not evict R1. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

No immediate health and safety risks were observed during this visit.

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: 08/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2024

LIC9099 (FAS) - (06/04)

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