<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604261
Report Date: 09/26/2024
Date Signed: 09/26/2024 04:43:48 PM


Document Has Been Signed on 09/26/2024 04:43 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: 36DATE:
09/26/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Front Desk Manager Yasmin Perez, and Activities Director Gabriela OrtizTIME COMPLETED:
05:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Sabel Martinez conducted a Case Management – Deficiencies visit. The LPA introduced himself and disclosed the purpose of the visit to Front Desk Manager Yasmin Perez and Activities Director Gabriela Ortiz.

During a complaint investigation visit conducted on 9/26/2024, it was revealed Staff # 1 (S1) and Staff # 2 (S2) did not have approved background clearances. This was confirmed through a review of staff records and a review of the Department's Background Guardian system. This deficiency was cited in an LIC 809D form and a civil penalty of $1,000 was assessed in an LIC 421 BG form. A Plan of Correction POC was jointly formulated with Staff Perez.

An exit interview was conducted with Perez and Ortiz to whom a copy of this report, a copy of the LIC 811 Confidential names list, LIC 421 BG, and Licensee Rights (LIC 9058), were provided.

SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 09/26/2024 04:43 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 09/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/26/2024
Section Cited
CCR
87355(e)(1)

1
2
3
4
5
6
7
87355 Criminal Record Clearance(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or
This requirement was not met as evidenced by:
1
2
3
4
5
6
7
 Front desk Manager and Actitvies DIrector agreed to not have S1 and S2 work at the facility until S1 and S2 obtained California background clearances.
8
9
10
11
12
13
14
Based on review of records, the Department's Background Guardian system, and interviews, the Licensee did not ensure S1 and S2 had criminal background clearances prior to working at the facility, which posed an immediate health, safety, and personal rights risk to 36 residents 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 TellezTELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 09/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/26/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2