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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604261
Report Date: 05/26/2023
Date Signed: 05/26/2023 12:17:28 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
06/12/2020 and conducted by Evaluator Tiffany Holmes
COMPLAINT CONTROL NUMBER: 08-AS-20200612121300
FACILITY NAME:AVANTGARDE SENIOR LIVING OF LA JOLLAFACILITY NUMBER:
374604261
ADMINISTRATOR:ESCOBAR, AGUSTINFACILITY TYPE:
740
ADDRESS:6211 LA JOLLA HERMOSA AVETELEPHONE:
(818) 692-5284
CITY:LA JOLLASTATE: CAZIP CODE:
92037
CAPACITY:45CENSUS: 30DATE:
05/26/2023
UNANNOUNCEDTIME BEGAN:
11:46 AM
MET WITH:Lynn Torino, Assistant Administrator TIME COMPLETED:
12:25 PM
ALLEGATION(S):
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Staff mishandled resident's medication while in care
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 Lynn Torino, Assistant Administrator . During the investigation, LPA toured the facility, conducted interviews and conducted a records review.

It was alleged staff mishandled resident's medication while in care. Interviews revealed that staff assist the residents with their medications. Interviews revealed Resident 1 (R1) recieves a medication that is based on their bloodwork. This means that either the medication will increase/decrease or stay the same amount after the bloodwork is reviewed. A review of the Medication and Administration Record (MAR) revealed an inconsistency in the resident recieiving their medication for the day of June. 30, 2020. Records show an empty space where staff initials should be once a medication is given to the resident. Interviews with staff did not reveal a reason on why the resident was not given their prescribed medication for that day. Interviews with staff revealed that if the resident refuses their medicaton it is marked with an R for refused. There is evidence that staff mishandled resident's medication while in care.

Based on the evidence obtained from the investigation, the above-mentioned allegation is substantiated. An exit interview was conducted with Lynn Torino, Assistant Administrator and a copy of this report and Licensee Rights (LIC 9058 03/22) was provided at the end of the visit.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2301
LICENSING EVALUATOR NAME: Tiffany HolmesTELEPHONE: (619) 481-0843
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023
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 2
Control Number 08-AS-20200612121300
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: 05/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/07/2023
Section Cited
CCR
87465(C)(2)
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87465(C)(2) Incidental Medical and Dental Care. Once ordered by the physician the medication is given according to the physician's directions. This requirement was not met as evidence by:
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Licensee agreed to conduct in service training on medication management to all med techs by an outside source called Polaris Pharmacy. Documentation of completion of training should be submitted to CCL by POC date of 06/07/2023.
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Based on interviews and records review, facility staff did not administer medications in accordance with physician’s orders for R1, which posed a potential health risk to 1 of 17 persons in care.
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Licensee will submit training materials & signatures of staff signin sheet to CCL by POC date of 06/07/2023.
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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: Simon JacobTELEPHONE: (619) 767-2301
LICENSING EVALUATOR NAME: Tiffany HolmesTELEPHONE: (619) 481-0843
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2