374604261-6-28-2024-08-AS-LTEZ-D6PT99-20240629143135

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604261
Report Date: 06/28/2024
Date Signed: 06/28/2024 10:03:41 AM

Substantiated

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
06/05/2024 and conducted by Evaluator Sabel Martinez

COMPLAINT CONTROL NUMBER: 08-AS-20240605121327

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: 38	DATE:	06/28/2024
		UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Wellness Director Susan Caccam		TIME COMPLETED:	10:15 AM

ALLEGATION(S):

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Wrongful Eviction.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced complaint investigation visit to deliver findings. The LPA introduced himself and disclosed the purpose of the visit to Wellness Director Susan Caccam.

Throughout the investigation, the Department secured pertinent records and conducted interviews with external and internal sources.

It was alleged the facility wrongfully evicted a resident. On 06/05/2024, it was reported to the Department Resident #1 (R1) was transported to a hospital and discharged from the facility.

The facility’s Regional Executive Director indicated R1 was not evicted, that R1’s responsible party/ Durable Power of Attorney (DPOA) had agreed to transfer R1 to a hospital for more aggressive treatment, as R1 was receiving hospice services. (See LIC 9099-C for continuation of report.)

Substantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel Martinez	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2024

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-20240605121327

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: 06/28/2024

NARRATIVE

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The hospice agency was allegedly notified of this change in care.

Interviews with said responsible party and hospice agency declined having any knowledge of R1’s transfer to a hospital, and only found out of the transfer once it had occurred.

Differing statements from interviews with internal and external sources revealed R1 was R1 own responsible party, that R1 was no longer able to pay R1’s monthly fees, that R1 was transported to a hospital to be transferred to a skilled nursing facility, and that R1 was not provided a 30-day eviction notice for lack of payment. These sources also revealed R1 would be accepted back to the facility once R1 was accepted to the Assisted Living Waiver Program.

Additionally, the facility was not able to produce records indicating R1 had a DPOA, nor that R1’s said responsible party had agreed for R1 to be transferred to a hospital.

Based on evidence obtained, the allegation was Substantiated. The deficiency was cited in accordance with California Code of Regulations, Title 22, and listed on the LIC 9099D. A $1,000 civil penalty was assessed in an LIC 421IM form, for a repeat violation within the last twelve (12) months. A plan of correction was jointly formulated with Wellness Director Caccam.

An exit interview was conducted with Caccam, to whom a copy of this report, LIC 9099D, LIC 811, LIC 421IM, and the Licensee/Appeals Rights (LIC 9058), were provided.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel Martinez	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2024

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20240605121327

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/28/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/28/2024 Section Cited CCR 87224(a)	1 2 3 4 5 6 7	87224 Eviction Procedures (a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required except as otherwise specified in paragraph (5). This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Wellness Director agreed to have facility management staff trained in eviction procedures. This training wiill be provided by an outside vendor and documentation of training and participants will be sent to the LPA, by July 26, 2024.
	8 9 10 11 12 13 14	Based of interviews and review of records, the licensee did not ensure R1 was provided a 30 day written notice, which posed a potential health, safety, and personal rights risk to 1 of 38 residnets in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel Martinez	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2024

LIC9099 (FAS) - (06/04)

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