374604261-8-9-2023-08-AS-DPOL-CV5TRM-20230828145746

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604261
Report Date: 08/09/2023
Date Signed: 08/09/2023 11:55:36 AM

Unsubstantiated

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
06/17/2020 and conducted by Evaluator Tiffany Holmes

COMPLAINT CONTROL NUMBER: 08-AS-20200617134433

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: 32	DATE:	08/09/2023
		UNANNOUNCED	TIME BEGAN:	11:07 AM
MET WITH:	Susan Caccam, Wellness Director		TIME COMPLETED:	11:20 AM

ALLEGATION(S):

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Staff did not obtain timely medical care for resident.
Staff did not report incident regarding resident to authorized representative.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tiffany Holmes conducted an unannounced visit to close out a complaint. LPA identified herself, was granted entry, and stated the purpose of the visit to Susan Caccam, Wellness Director. During the investigation, LPA toured the facility, conducted interviews and conducted a records review.

It was alleged staff did not obtain timely medical care for resident. Interviews revealed that Resident 1 (R1) got a spider bite on their left side on upper leg. The bite started to get inflamed by swelling up, and was red. Interviews revealed staff saw the bite and notified the Wellness director. On Monday 6/8/2020 Wellness DIrector was made aware of the bite and the facility physician Dr. Poses, observed the client and prescribed ointment and sent a wound specialist to see R1. Interviews revealed that R1 did not require any medical attention when staff first observed R1 but a couple of days later they needed care.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR NAME: Tiffany Holmes	TELEPHONE: (619) 481-0843
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023

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-20200617134433

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: 08/09/2023

NARRATIVE

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Interviews revealed that the Dr that saw R1 recommended a wound care specialist to see R1. The specialist came on June. 5,2023 and cleaned the bite area/wound. Documentation shows the specialist packed the wound 3 times after cleaning out puss and some necrotic tissue. The wound specialist packed it with gauze and covered it with gauze as well. Interviews revealed that once they saw the bite go from a bite to being infected they consulted with the doctor and received medical attention.

It was alleged staff did not report incident regarding resident to authorized representative. Interviews revealed that Resident 1 (R1) was bitten by a spider that was in one of the plants that their caregivers brought in. The bite was reported to the responsible party once the doctor had to come in and see the resident and after the bite turned into a wound. Interviews revealed the responsible party was aware of bite and wound care treatment. There was no incident report filled out due to it being a spider bite. Interviews did not reveal any evidence of staff did not report incident regarding resident to authorized representative.

Based on the evidence obtained from the investigation, the above-mentioned allegations are unsubstantiated. An exit interview was conducted with Susan Caccam, Wellness Director and a copy of this report and Licensee Rights (LIC 9058 03/22) was provided at the end of the visit.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR NAME: Tiffany Holmes	TELEPHONE: (619) 481-0843
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023

LIC9099 (FAS) - (06/04)

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