197608081-8-9-2024-31-AS-NMAN-DAAUPG-20241022154531

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608081
Report Date: 08/09/2024
Date Signed: 08/09/2024 01:04:21 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:	08/09/2024
		UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Joyce Martinez		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Staff did not safeguard resident’s personal belongings

INVESTIGATION FINDINGS:

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At 8:50 a.m. on 08/09/24, 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 allegation 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, inventory sheet, 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. LPA conducted a subsequent visit on 08/01/24 and interviewed Staff #3 (S3) at 1:30 p.m. and Staff #4 (S4) at 1:45 p.m. Today, LPA conducted an additional record review at 10:45 a.m. and called staff #5 (S5) for an interview at 12:00 p.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: 08/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2024

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: 08/09/2024

NARRATIVE

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Regarding the allegation “Staff did not safeguard resident’s personal belongings”, it was alleged some of R1’s belongings were not transferred to their current residence. Interview with R1 revealed they were missing a dresser, a monitor, a blanket, shirts, compression socks, sodas, waters, and a wheelchair. Record review of R1’s personal property sheet from 09/10/2021 revealed they listed compression socks, shirts, a monitor, and a blanket on their property sheet upon admission. Another personal property sheet from 08/07/23 revealed a t-shirt, blanket, and computer screen were provided by the facility upon discharge. Interview with the administrator revealed S4 is responsible for transferring resident belongings upon leaving. Interview with S4 revealed the SNF had limited space, so about half of R1’s belongings were boxed up and sent to the SNF. S4 said some time later, they boxed up the rest of R1’s belongings and sent them to their current residence. S4 also stated that the wheelchair was not R1’s but was loaned from the facility. The SNF social worker confirmed that the SNF had limited space for belongings, but they did not recall what belongings R1 had at the SNF. S5, who works at R1’s current residence, stated they were in charge of resident belongings and new admissions. S5 had no recollection of R1’s belongings transferred during intake. Interviews with S2 and S3 revealed that they remembered R1’s belongings getting boxed up and driven to their new facility. S2 also recalled that two employees from R1’s SNF came to pick up some of R1’s belongings around June 2023. Based on interviews and record reviews, the facility properly safeguarded R1’s belongings and sent them to R1’s SNF and new residence. Therefore, the allegation is 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: 08/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2024

LIC9099 (FAS) - (06/04)

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