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Department of
SOCIAL SERVICES
Community Care Licensing
COMPLAINT INVESTIGATION REPORT
Facility Number:
197608081
Report Date:
09/27/2021
Date Signed:
09/27/2021 01:50:57 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
01/27/2021
and conducted by Evaluator
Wendell Smith
COMPLAINT CONTROL NUMBER:
31-AS-20210127105116
FACILITY NAME:
AVANTGARDE SENIOR LIVING OF TARZANA
FACILITY NUMBER:
197608081
ADMINISTRATOR:
ERIN MAHONEY
FACILITY TYPE:
740
ADDRESS:
5645 LINDLEY AVENUE
TELEPHONE:
(818) 881-0055
CITY:
TARZANA
STATE:
CA
ZIP CODE:
91356
CAPACITY:
138
CENSUS:
107
DATE:
09/27/2021
UNANNOUNCED
TIME BEGAN:
11:15 AM
MET WITH:
Carolina Garcia'Trejo
TIME COMPLETED:
01:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff failed to check on residents in a timely manner
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced subsequent visit to further investigate the allegation above. LPA met with the administrator and explained the reason for this visit.
Regarding the allegation above it is alleged that staff failed to check on residents in a timely manner when they pushed their pendant in their room. LPA had previously conducted visits regarding this allegation on 6/18/21 and 1/29/21. During today's visit LPA conducted interviews with random residents regarding the allegation from 11:30-12:30pm. Based on the information obtained during interviews this allegation is still deemed Unsubstantiated. Exit Interview conducted.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME:
Cassandra Harris
TELEPHONE:
(818) 596-4342
LICENSING EVALUATOR NAME:
Wendell Smith
TELEPHONE:
(818) 738-4525
LICENSING EVALUATOR SIGNATURE:
DATE:
09/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/27/2021
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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