197608081-5-15-2025-31-AS-NMAN-DPEUB7-20251216142552

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608081
Report Date: 05/15/2025
Date Signed: 05/15/2025 11:16:14 AM

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
05/13/2025 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20250513150549

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: 122	DATE:	05/15/2025
		UNANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:	Joyce Martinez		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Facility charged resident more than the basic SSI rate

INVESTIGATION FINDINGS:

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At 8:20 a.m. on 05/15/25 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with staff and later the Marketing Director and disclosed the reason for the visit.

To investigate the allegations above, LPA toured the facility inside and out at 8:30 a.m., conducted a record review of pertinent records, including but not limited to an admission agreement and staff and client rosters at 8:45 a.m., and interviewed staff between 9:00 a.m. and 11:00 a.m. today.

Regarding the allegation "Facility charged resident more than the basic SSI rate" it was alleged Resident #1 (R1) was charged rent higher than the California standards for Supplemental Security Income (SSI). Records of R1’s admission agreement were provided prior to the investigation and showed they paid $1344.82 for a base fee and an additional $1300 for a private room fee starting on 11/18/23. R1 had a new contract as of 11/01/24 in which they paid $1344.82 for a base fee and an additional $700 for a private room fee.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025

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-20250513150549

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: 05/15/2025

NARRATIVE

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The SSI standard rates for Non-Medical Out-of-Home Care (NMOHC) Payment Standard have been $1492.82 for 2023, $1575.07 for 2024, and $1599.07 for 2025. Record review of R1’s admission agreement revealed they were admitted on 11/18/23. R1’s admission agreement was signed by their representative, Visitor #1 (V1). R1’s funding source was listed as both their Social Security and family. R1 was initially charged $1344.82 for basic services with Assisted Living Waiver (ALW) funds covering their cost of care. Since R1 and V1 elected for a private room, the facility charged an additional fee. Review of the Social Security Administration’s Program Operations Manual System (POMS) Chapter SI SF01415.120 California Optional State Supplement indicates “The State provides a breakout of standard charges each year for NMOHC facilities... However, a recipient’s written admission agreement may include additional charges if a resident chooses a private room when a double room is available... The facility should be able to provide the actual charges for room and board as specified in the written agreement”. Interview with Staff #1 (S1) at 10:15 a.m. today revealed a meeting was held in 2024 to discuss R1’s monthly rent rate. In the meeting, S1 and R1’s ALW service coordinator, Visitor #2 (V2) explained to R1's representatives that a private room fee can be established by the facility and documented in the admission agreement. Telephonic interview with V2 at 10:40 a.m. today confirmed that they explained the conditions of private room fees to R1's representatives. Based on interviews and record review, V1 signed R1’s admission agreement which included the private room fee. R1 paid rent each month from their SSI funds in accordance to the applicable payment standards, and the remaining balance was paid from family. The facility did not charge a base fee more than the SSI rate. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Exit interview conducted. Copy of report provided.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025

LIC9099 (FAS) - (06/04)

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