374604261-5-15-2024-08-AS-LTEZ-D5QV9H-20240529161424

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604261
Report Date: 05/15/2024
Date Signed: 05/15/2024 10:48:41 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/17/2023 and conducted by Evaluator Renita Hall

COMPLAINT CONTROL NUMBER: 08-AS-20231017141017

FACILITY NAME:	AVANTGARDE SENIOR LIVING OF LA JOLLA		FACILITY NUMBER:	374604261
ADMINISTRATOR:	ESCOBAR, AGUSTIN		FACILITY TYPE:	740
ADDRESS:	6211 LA JOLLA HERMOSA AVE		TELEPHONE:	(818) 692-5284
CITY:	LA JOLLA	STATE: CA	ZIP CODE:	92037
CAPACITY:	45	CENSUS: 37	DATE:	05/15/2024
		UNANNOUNCED	TIME BEGAN:	09:33 AM
MET WITH:	Susan Caccam, Wellness Director		TIME COMPLETED:	10:55 AM

ALLEGATION(S):

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Staff did not meet resident’s dietary needs resulting in weight loss
Resident was not assisted with getting in and out of bed
Staff overmedicated resident
Resident sustained an unexplained injury while in care
Staff did not safe guard resident belongings

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Renita Hall conducted an unannounced visit to deliver findings. LPA was allowed entry by Susan Caccam, Wellness Director. LPA identified herself and disclosed the purpose of the visit and elements of the findings to the Wellness Director.

On October 17, 2023, the Department received a complaint regarding the following allegations: Staff did not meet resident's dietary needs resulting in weight loss, Resident was not assisted with getting in and out of bed, Staff overmedicated resident, Staff did not safeguard resident personal belongings, and Resident sustained an unexplained injury while in care.

On October 19, 2023, the department conducted interviews with staff and residents, obtained records, and conducted a tour of the facility.

Continuted on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Renita Hall	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024

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 08-AS-20231017141017

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 JOLLA	FACILITY NUMBER: 374604261
	VISIT DATE: 05/15/2024

NARRATIVE

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Resident 1 (R1) stated that they eat food in smaller portions and have not experienced any weight loss due to dietary negligence. The staff stated that R1 was on a liquid diet before living at the facility. LPA reviewed the physician's report that supports the dietary needs of the resident as "on a fortified diet with thin liquids for aspiration risks."

Allegation 2: Resident was not assisted with getting in and out of bed. R1 expressed like to try to do it on their own and admitted to needing assistance but do not like to wait for staff.

Allegation 3: Staff over medicated resident. Resident 1 denied being over medicated by the staff during the investigation. Medications are being administered as per the prescribed schedule.

Allegation 4. Staff did not safeguard residents' personal belongings. Resident 1 confirmed that their glasses and cell phone were missing. Staff stated that R1 had broken their glasses and was waiting for the in-house Optometrist to prescribe new prescription for glasses and that R1 did not have a cell phone at the time of admission to the facility. A review of the LIC 621 indicated that R1 had 1 blue suitcase and declined to write the personal property inside. When LPA toured inside R1's room, 1 blue suitcase and clothing were inside the closet which coincided with the LIC621.

Allegation 5. Resident sustained an injury while in care. Resident 1 mentioned that they sustained an injury due to falling when they attempted to get out of bed without assistance. R2 confirmed the fall by R1 and they called for assistance to help R1 when they fell.

Based on the findings of the investigation, it is determined that the allegations against Avantgarde Senior Living of La Jolla: Staff did not meet resident's dietary needs resulting in weight loss, Resident was not assisted with getting in and out of bed, Staff over medicated resident, Staff did not safeguard resident personal belongings, and Resident sustained an unexplained injury while in care are Unsubstantiated. An unsubstantiated finding means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

An exit interview was conducted and a copy of this report along with the Licensee Rights (LIC 9058) was provided to the Wellness Director. Her signature on this form confirms receipt of the documents.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Renita Hall	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024

LIC9099 (FAS) - (06/04)

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