374604261-6-13-2023-08-AS-LTEZ-CT9TSW-20230629145950

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604261
Report Date: 06/13/2023
Date Signed: 06/13/2023 03:37:13 PM

Unsubstantiated

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
05/05/2023 and conducted by Evaluator Sabel Martinez

COMPLAINT CONTROL NUMBER: 08-AS-20230505110950

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:	06/13/2023
		UNANNOUNCED	TIME BEGAN:	02:40 PM
MET WITH:	Regional Executive Director, Carolina Trejo		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Facility is not mitigating outbreak

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 Regional Executive Director, Carolina Trejo.

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

It was alleged the facility did not mitigate an outbreak. It was reported to the Department a resident was admitted with a communicable disease. Three additional residents and two staff allegedly contracted the disease due to a lack of mitigation. Interviews with internal and external sources revealed only one resident had a previous positive diagnosis of the disease in question. Staff reviewed the resident's medical history and identified the resident had a history of a reoccuring disease. As a precautionary step, staff placed Personal Protective Equipment (PPE) outside of the resident’s room for staff to don while providing care, (See LIC 9099C for continuation of report.)

Unsubstantiated

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: 06/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023

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-20230505110950

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: 06/13/2023

NARRATIVE

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Lab test were also ordered to confirm, or rule out an active diagnosis. Observations by the Licensing Program Analyst corroborated the PPE was outside of the room, and staff were donning the PPE prior to entering the resident's room. Review of records revealed the resident's test was negative for the disease.

Based on the evidence gathered throughout the investigation, there was not a preponderance of evidence to prove the alleged violation occurred, therefore, the allegation was Unsubstantiated.

An exit interview was conducted with Regional Executive Director, Trejo, to whom a copy of this report, 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: 06/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023

LIC9099 (FAS) - (06/04)

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