374604261-7-20-2023-08-AS-LTEZ-CU9VUX-20230731164527

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604261
Report Date: 07/20/2023
Date Signed: 07/20/2023 11:23:47 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
07/06/2023 and conducted by Evaluator Sabel Martinez

COMPLAINT CONTROL NUMBER: 08-AS-20230706144325

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:	07/20/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Wellness Director, Susan Caccam and Social Services Director, Ana Navarro		TIME COMPLETED:	11:40 AM

ALLEGATION(S):

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Illegal 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 and Social Services Director, Ana Navarro.

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

It was alleged the facility illegally evicted Resident # 1 (R1). It was reported to the Department R1 had left the facility, had a medical emergency, and was transported to the hospital on, or about June 27th, 2023. R1 was not allowed to return to the facility once R1 was ready for discharge from the hospital.

Interviews with internal and external sources, confirmed R1 was able to leave the facility and often did. It was common for R1 to leave and return later in the evenings.
(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: 07/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023

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-20230706144325

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: 07/20/2023

NARRATIVE

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It was also revealed R1 had expressed a desire to move out and R1 had requested assistance from case management in finding new placement.

Although, an interview revealed a conflicting statement regarding R1 stating R1 would be leaving and not returning to the facility on June 27th, a review of the Incident Report submitted to the Department and interviews contradicted this statement. Incident Report submitted to the Department indicated R1 had left the facility on June 27th to conduct errands. On June 28th, R1 called the facility, spoke to staff and notified staff R1 was hospitalized. Additionally, an external source provided the LPA electronic mail communication indicating R1’s room had been closed and referencing lack of payment.

Based on evidence obtained, the facility did not provide R1 written notice, therefore, 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 Social Services Director, Ana Navarro

An exit interview was conducted with Wellness Director, Susan Caccam and Social Services Director, Ana Navarro, to whom a copy of this report, LIC 9099D, LIC 811 and 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: 07/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20230706144325

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: 07/20/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/20/2023 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	Social Services Director agreed to provide all staff in services training regarding eviction procedures, by 8/18/23.
	8 9 10 11 12 13 14	Based on review of records and interviews, the licensee did not ensure R1 was provided a 30 day written notice, which posed a potential helath, safety, and personal rights risk to 1 of 30 residents in care.	8 9 10 11 12 13 14	Social Services Director agreed to submit documentation confirming date of training and staff who attended, by 8/18/23.
	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: 07/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023

LIC9099 (FAS) - (06/04)

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