374604261-6-9-2023-08-AS-LTEZ-CT9M7N-20230629092149

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604261
Report Date: 06/09/2023
Date Signed: 06/09/2023 01:58:18 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/05/2023 and conducted by Evaluator Sabel Martinez

COMPLAINT CONTROL NUMBER: 08-AS-20230605163635

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:	06/09/2023
		UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Care Coordinator, Ivan Dave		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility did not provide responsible party a refund

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA), Sabel Martinez, conducted an unannounced complaint investigation visit to open a complaint and deliver findings. The LPA introduced himself and disclosed the purpose of the visit to Care Coordinator, Ivan Dave.

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

It was alleged the facility did not provide a responsible party a refund. It was reported to the Department the facility did not refund Resident # 1’s (R1) community fee as indicated during the admission process. Interviews with internal and external sources revealed R1’s responsible party and facility personnel had communicated regarding the refund, agreed on the amount, but a refund was not yet processed. Review of R1's admission agreement revealed the facility did not provide full written disclosure of preadmission fee charges and refund conditions. (See LIC 9099C for continuation of report.)

Substantiated

Estimated Days of Completion: 90

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (610) 767-2317
LICENSING EVALUATOR NAME: Sabel Martinez	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 08-AS-20230605163635

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: AVANTGARDE SENIOR LIVING OF LA JOLLA	FACILITY NUMBER: 374604261
	VISIT DATE: 06/09/2023

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
26
27
28
29
30
31
32

Based on evidence obtained throughout the investigation, the allegation was Substantiated. 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 Care Coordinator, Ivan Dave.

An exit interview was conducted with Care Coordinator, Ivan Dave, to whom a copy of this report, LIC 9099D LIC 811 and Licensee/Appeals Rights (LIC 9058) were provided.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (610) 767-2317
LICENSING EVALUATOR NAME: Sabel Martinez	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 08-AS-20230605163635

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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: 06/09/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/09/2023 Section Cited CCR 87507g5E1.b.	1 2 3 4 5 6 7	87507 Admission Agreements (g) Admission agreements shall specify the following:(5) Refund conditions.(E) Preadmission fees shall be refunded according to the following conditions: (1.)A 100 percent refund of a preadmission fee shall be provided to an applicant or the applicant’s representative if:(b.) b. The licensee fails to provide full written disclosure of preadmission fee charges and refund conditions.This requirement was not met as evidenced by:	1 2 3 4 5 6 7	The LPA received documetns confirming the Responsible party received a check for the refund amount, today 6/9/23. POC cleared on today's date.
	8 9 10 11 12 13 14	Based on interviews and review of records the, the Licensee did not ,refund 100 percent of a preadmission fee, which posed a potential health, safety and personal rights risks to 1 of 30 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: Denise Powell	TELEPHONE: (610) 767-2317
LICENSING EVALUATOR NAME: Sabel Martinez	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 3