374604261-2-28-2025-08-AS-LTEZ-DEDQVJ-20250302113022

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604261
Report Date: 02/28/2025
Date Signed: 02/28/2025 10:08:44 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
09/19/2024 and conducted by Evaluator Sabel Martinez

COMPLAINT CONTROL NUMBER: 08-AS-20240919132510

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: 30	DATE:	02/28/2025
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Administrator Susan Caccam		TIME COMPLETED:	10:25 AM

ALLEGATION(S):

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Staff did not assist resident with incontinence care

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 visit to Administrator Susan Caccam.

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

It was alleged staff did not assist a resident with incontinence care. On September 19th, 2024, it was reported to the Department Resident #1 (R1) often had to wait thirty to forty minutes before being assisted with incontinence brief changes. During mealtimes, R1 was allegedly told R1 needed to wait until a staff was available.

Review of R1’s records, including a physician’s report, preplacement appraisal, and Assisted Living Waiver (AWL) assessment, revealed R1 was diagnosed with bladder and bowel impairment.

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: 02/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2025

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-20240919132510

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: 02/28/2025

NARRATIVE

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Chronic/ intermittent diarrhea was noted in these documents.

An interview with an external source revealed the concern of lack of incontinence care was discussed during resident council meetings. This source addressed this concern with management, but it was not addressed.
Interviews with internal sources, including R1, revealed there were instances when R1 had to wait up to forty minutes to be assisted with brief changes. Each shift had two caregivers and one medication technician on duty. The two caregivers were assigned to respond to resident calls and assist residents with incontinence care. The medication technician was assigned to pass medications. These sources also corroborated that during mealtimes R1 had to wait until caregivers were available. Interviews revealed there were approximately six to seven residents who required assistance with feeding, which required both caregivers to assist those residents during mealtimes. Interviews consistently disclosed most of the residents in care required assistance with incontinence care.

Although there were contradicting statements on if medication technicians, kitchen staff, and administrative staff assisted the caregivers, there was enough evidence to substantiate the allegation.

The deficiency was cited in accordance with California Code of Regulations, Title 22, and listed on the LIC 9099D. A plan of correction was jointly formulated with Administrator Caccam.

An exit interview was conducted with Administrator Caccam, to whom a copy of this report, LIC 9099D, and Licensee/Appeals Rights (LIC 9058), were provided via email. An email read receipt confirmed the documents were received by the administrator.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel Martinez	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2025

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20240919132510

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: 02/28/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/28/2025 Section Cited CCR 87425b(3)	1 2 3 4 5 6 7	87425 (b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Administrator agreed to train all staff on managed incontinence and submit proof to the LPA by 3/28/2025.
	8 9 10 11 12 13 14	Based on review of records, the Licensee did not ensure one incontinent resident was kept clean and dry, which posed a potential health, safety, and personal rights risk to 1 of 30 persons 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: 02/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2025

LIC9099 (FAS) - (06/04)

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