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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604261
Report Date: 05/02/2024
Date Signed: 05/02/2024 01:28:29 PM


Document Has Been Signed on 05/02/2024 01:28 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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: 39DATE:
05/02/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Wellness Director Susan Caccam and Office Manager Yasmin PerezTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced Continuation Annual Inspection. The LPA identified himself to, and discussed the purpose of the visit with Office Manager Yasmin Perez. Wellness Director Susan Caccam arrived during the visit and assisted the LPA.

The facility was licensed for a capacity of forty-five (45), of which all may be bedridden. The facility was also approved for delayed egress, and a hospice waiver for twenty (20).

During the inspection the LPA, accompanied by staff, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities.

There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored.
Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to residents.
Medications were labeled, and stored in a locked area. No pools or bodies of water were observed on the premises. Per staff, no firearms or ammunition were kept at the facility. Carbon monoxide detectors, facility telephone and a fire extinguisher were in working order.

The LPA interviewed staff and reviewed multiple staff and client records/files. No deficiencies were cited during today's annual inspection.

An exit interview was conducted with Wellness Director Caccam, to whom a copy of this report, and the Licensee/Appeal Rights (LIC9058), were provided.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/02/2024
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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