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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604261
Report Date: 09/08/2020
Date Signed: 09/09/2020 09:30:19 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:AVANTGARDE SENIOR LIVING OF LA JOLLAFACILITY NUMBER:
374604261
ADMINISTRATOR:ESCOBAR, AGUSTINFACILITY TYPE:
740
ADDRESS:6211 LA JOLLA HERMOSA AVETELEPHONE:
(818) 692-5284
CITY:LA JOLLASTATE: CAZIP CODE:
92037
CAPACITY:45CENSUS: 16DATE:
09/08/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Lee Stotts, AdministratorTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA), Laarni Santiago, contacted the facility via telephone to conduct a Case Management Visit - Other regarding an Exclusion Order for an individual. The visit is being conducted via telephone call due to COVID-19. LPA identified herself and explained the purpose of the call to Administrator, Lee Stotts.

The Exclusion Order implies that Staff 1 (S1) {See LIC 811 confidential list to identify S1} was associated to Season's of La Jolla, #374601248. The facility have gone through a change of ownership effective April 27, 2020, and is now Avantgarde Senior Living of La Jolla, #374604261. Interviews were conducted with current Administrator, former Administrator and former staff that had previously worked at Seasons of La Jolla and all were able to confirm that S1 was never employed with the facility. There were no records on file at the facility that suggest that S1 was ever employed with the facility. The Administrator agrees and understands that S1 cannot be on the premises. S1's association ended with Seasons of La Jolla on April 27, 2020. No deficiencies were issued.

An exit interview was conducted with Administrator, Lee Stotts, and a copy of this report, along with Licensee/Appeal Rights (LIC 9058 01/16), were provided to the Administrator via electronic mail. An electronic read receipt confirms receipt of the documents.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 318-5974
LICENSING EVALUATOR NAME: Laarni SantiagoTELEPHONE: (619) 318-5974
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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