Avantgarde Senior Living of la Jolla.

Investigation Revealed the Following: Allegation: Staff do not provide activities to residents. The details of the complaint alleged that facility does not provide activities that offer cognitive stimulation for residents in care. On April 12, 2026, at approximately 10:00 a.m., during the records review process, the Department reviewed copies of the facility’s activity calendars from November 2025 through April 2026. The review indicated that, while the calendars included routine social, recreational, and physical activities, they did not comply with all the elements required under Title 22, Section 87219. Specifically, the calendars did not show activities related to daily-living skills training, sensory-based programs, resident participation in the planning or evaluation of activities, utilization of community resources, or dedicated free-time periods that allow residents to choose activities independently. In addition, the department reviewed copies of the Medical Assessment for Residential Care Facilities for the Elderly or LIC 602A, dated variously, and noted that (15) has cognitive impairment. These missing activities are particularly significant as they are specifically designed to improve the quality of life of the (15) residents with cognitive impairment currently living at the facility, supporting their independence, engagement, and overall, well-being. On April 11, 2026, during an interview with the facility administrator (A#1), (A#1) stated that that (15) residents at the facility have a cognitive impairment and are dependent on facility staff for all aspects of care, supervision, and stimulation. 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 During this investigation, LPA found sufficient evidence to support the above-mentioned allegation. Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), the above-mentioned deficiency was observed, and citation issued (ref. LIC 9099D). An exit interview was conducted, and a copy of the Complaint Report was given to Susan Caccam/Facility Administrator.

Investigation Revealed the Following: Allegation: Staff did not provide a healthful accommodation to the residents The details of the complaint alleged that facility was not clean and sanitary On April 7, 2026, at approximately 9:00 a.m., during a health and safety inspection of the facility, the Department conducted a random check of ten (10) resident rooms. The Department observed that (10) out of (10) rooms had carpet stains and trash scattered throughout. During this investigation, LPA found sufficient evidence to support the above-mentioned allegation. Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), the above-mentioned deficiency was observed, and citation issued (ref. LIC 9099D). An exit interview was conducted, and a copy of the Complaint Report was given to Susan Caccam/Facility Administrator. 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 Investigation Revealed the Following: Allegation: Staff did not properly groom a resident The details of the complaint alleged that facility staff did not properly dress (R#1) with the appropriate clothes On April 7, 2026, at approximately 10:00 am, during an interview with (R#1), the Department observed that (R#1) was dressed in clean clothing appropriate for the day’s weather. The Department asked (R#1) who selected the clothing they were wearing, and (R#1) stated that they chose the clothing themselves. On April 11, during an interview with the facility administrator (A#1), (A#1) stated that facility staff are trained to select appropriate clothing for residents based on current weather conditions. (A#1) further stated that when residents have the ability to choose their own clothing, staff allow them to do so while providing guidance as needed. In addition, (A#1) was also asked about the systems in place to ensure residents have access to their personal clothing and that staff utilize clothing provided by family members. (A#1) stated that each resident has their own closet where personal clothing is stored. According to (A#1), facility staff place clean clothing in the residents’ closets after laundering to ensure items are available and accessible. On April 11, during interviews with residents in care (R#1 through R#7), residents were asked whether staff assist them regularly with grooming, including dressing, brushing hair, and bathing, and whether the assistance is appropriate for their needs. Evaluation Report continues LIC 9099-C 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 (3) out of (7) Residents stated that they perform their own dressing and grooming; however, they observed that staff assist other residents who require help. In addition, residents were also asked if they had ever been dressed in clothing that felt uncomfortable or inappropriate for the weather. (7) out of (7) residents stated that they had no concerns and that everything was appropriate. On April 11, 2026, during interviews with facility staff (S#1 through S#3),(3) out of (3) facility staff stated that they assist residents with showers, changing clothes, and escorting residents to the dining room as part of their grooming and dressing responsibilities. Staff reported that the level of assistance provided varies depending on each resident’s needs and level of independence. In addition, staff were also asked how they ensure that residents are dressed in a manner that is comfortable and appropriate for their needs, including weather-appropriate clothing. (3) out of (3) staff stated that they offer residents multiple clothing options and encourage residents to choose their preferred items when possible. Allegation: Staff mishandled a resident's personal belongings The details of the complaint alleged that facility staff did safeguard (R#1)’s personal belongings On April 7, 2026, at approximately 2:00 pm, during the records review, the department observed a copy of (R#1) client/resident personal property and valuables or LIC 621 dated 9/26/23. Evaluation Report continues LIC 9099-C 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 The department noted that (R#1) had listed on the form (4) shirts, (4) pants, (1) purse, (1) pair of glasses, (1) jacket, and (1) blanket. During the health and safety of (R#1)’s room, the department observed the items listed on the LIC 621 in (R#1)’s dresser. On April 11, during an interview with the facility administrator (A#1), (A#1) stated that the resident’s clothing was not missing. (A#1) explained that due to (R#1)’s cognitive impairment, the facility keeps additional clothing for (R#1) stored in another section of the building. (A#1) reported that staff maintain a rotation system in which a portion of (R#1)’s clean clothing is placed into (R#1)’s chest of drawers and closet, and once those items are used, staff replenish the drawers and closet with more clean clothing from the stored supply. In addition, when asked how the facility ensures residents consistently have access to their personal clothing and how staff maintain accountability for resident property, (A#1) stated that (R#1) has a chest of drawers and a closet inside the resident room. (A#1) further stated that staff are responsible for placing an adequate amount of clothing in these areas and refilling them as needed after items are worn or laundered. On April 11, during interviews with residents in care (R#1 through R#7), (7) out of (7) residents stated that had not experienced issues with personal clothing or belongings going missing. When asked, “Have you ever had any personal clothing or belongings go missing or not returned to you?” each resident responded with statements such as, “Not that I can think of.” Residents were also asked whether they felt staff keep track of their belongings and return clothing after it is washed. (7) out of (7) residents stated that they believed staff manage clothing appropriately . Evaluation Report continues LIC 9099-C 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 On April 11, 2026, during interviews with facility staff (S#1 through S#3),(3) out of (3) facility staff stated that that they follow established procedures to keep track of residents’ clothing and personal items. When asked, “What steps do you take to keep track of residents’ clothing and personal items?” staff reported that during the admission process, an inventory list is completed which documents the residents’ personal belongings, including clothing. In addition, when asked how staff handle situations where a resident’s belongings cannot be located, (3) out of (3) stated that, due to serving residents with cognitive impairment, the facility often keeps residents’ clothing in the laundry room to ensure clothing does not become misplaced. Staff reported that when a resident needs clothing, they provide the items directly from the supply kept in the laundry area. During this investigation, LPA did not find sufficient evidence to support the above-mentioned allegation(s). Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) are found to be UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted, and a copy of the Complaint Report was given to Susan Caccam/ Facility Administrator.

[Continued from LIC 9099] R1 is a non-ambulatory resident at the facility who utilizes a motorized wheelchair. Per R1's physician's report, they are able to leave the facility unassisted and have no diagnosis of Mild Cognitive Impairment (MCI) or Dementia. On 10/7/25 the facility issued a 30-day notice to R1, and a copy was shared to the Department. Per review of the notice, it was discovered that the a phone number on the notice for appeals information was incorrect. LPA informed the facility of the technicality and that the notice was now invalid. On 11/10/25, the facility issued a new and corrected 30-day notice to R1, the reasons remaining the same: 1. Failure to comply with the house rules and policies of the facility 2. Engaging in behavior which is a threat to the mental and/or physical safety of others in the facility 3. Noncompliant with recommended medical treatment 4. Methamphetamine abuse per discharge papers for a hospital stay in September 2025 5. Suspected camera in R1's room 6. Resident cannot operate well in their electric wheelchair. Per the notice, sections 11 (house rules/policies) and 20 (conditions for eviction) of R1's admissions agreement contract were specified. Review of R1's admissions agreement revealed that under section 20 (conditions for eviction), subsection (D)(1): " The reasons relied upon for the eviction, with specific facts to permit determination of the date, place, witnesses, and circumstances concerning those reasons." Additionally, under section 11 (house rules/policies) it is noted that "failure to comply may result in a written warning. After sufficient warning, a notice of eviction will be given to the resident and/or responsible person." The notice itself did not supply specific incidents or information regarding the reasons for eviction. Per interview with administrative staff, it was revealed that no written documentation of incidents or previous meetings with R1 regarding their alleged misbehavior/facility concerns were held. It was revealed that verbal warnings were issued, but no documentation of such was able to be provided. An outside source interviewed revealed that they had received no supporting documentation from the facility for the reasoning for eviction. Another outside source interviewed revealed concerns that there was no substantial basis for the eviction in the first place, labeling it "suspicious." [Continued on LIC 9099-C] 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 [Continued from LIC 9099-C] Per interviews with administrative staff, the main reasoning for the eviction was drug use, R1 leaving the facility and coming back "late at night," R1 having a camera in their room, and concerns about R1's ability to operate their wheelchair properly. Per review of medical discharge papers for R1's hospital stay in September 2025, one of the discharge diagnoses was "methamphetamine abuse." However, review of facility rules do not include anything against the use of drugs in the facility, only that smoking must be done outside the facility and in designated areas. One (1) staff member interviewed revealed that they have observed R1 smoking outdoors and down the street. Interview with R1 also corroborated that they smoke outside of the facility. In regards to coming and going from the facility, file review of R1's physician's report reveal that R1 is able to leave the facility unassisted, therefore the facility cannot necessarily restrict R1 from coming and going as they please. Additionally, staff interviews and file review of resident sign-in/out records corroborated that R1 does inform staff when they leave and that they sign out at the front desk. While multiple staff interviews corroborated that R1 does often return late at night, R1 is not disruptive when they return. However some staff interviews revealed that R1 does return appearing intoxicated at times. Several staff members interviewed revealed that R1 was in possession of the secured door code and is able to let themselves in at night, which again is not specifically outlined in the admissions agreement to be against house rules/policies. In regards to R1 having a camera in their room, again the facility rules do not include rules or policies regarding a resident setting a personal camera in their room. Staff interviews revealed concern for the privacy of R1's roommate. Interview with R1's roommate revealed that they were alright with the presence of the camera so long they were not included in the frame. Interview with R1 revealed the camera only records video and not audio, thus complying with applicable California State laws. Additionally, a notice was placed outside R1's room, providing notice of recording in progress inside. [Continued on LIC 9099-C] 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 [Continued from LIC 9099-C] Regarding concerns with R1's ability to utilize their wheelchair, per R1's admissions agreement, all residents with motorized wheelchairs must have a doctor's note certifying the resident can operate it safely. Administrative staff confirmed R1 had a doctors note certifying approval upon move in. Staff interviews revealed mixed sentiments regarding R1's wheelchair use. While most acknowledged R1 has bumped and scraped doorways and corners with their wheelchair, two (2) stated that damages were not done on purpose, mentioning that R1 does try to be careful but that their wheelchair is wide, leading to occasional scrapes when navigating. Another two (2) staff interviewed revealed they believed the damages to be attributed to R1 being intoxicated and thus unable to steer correctly. File review of photos documented by the facility of property damage depict horizontal scrapes/markings on the lower half of R1's unit door. One additional photo of the exit door near R1's room also to have several scrapes, less in amount than shown on R1's door. Based on LPA's review of records, interviews with staff, residents, and outside sources, the preponderance of evidence standard has been met, therefore the above allegation of unlawful eviction is found to be SUBSTANTIATED. A deficiency is being cited per California Code of Regulations, Title 22, Division 6 on the attached 9099D. An exit interview was conducted with Administrator Caccam to whom a copy of this report and the Licensee/Appeal Rights (LIC 9058) were provided. Their signature below confirms receipt of these documents.

Licensing Program Analyst (LPA) Arian Golbakhsh conducted an unannounced, required Annual Inspection. The facility file and personnel report was reviewed prior to the visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit to Office Manager Carolina Diaz. Administrator Susan Caccam arrived later in the visit. The facility is approved for a capacity of forty-five (45) non-ambulatory residents, all of which may be bedridden. The facility also has a hospice waiver for twenty (20). During today’s inspection there were thirty (30) residents in care. LPA and Administrator Caccam toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Hot water temperature at taps accessible to clients were compliant: Bathroom sink was in one client bedroom was 107F. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility contained at least two (2) days of perishable food, and at least seven (7) days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. [Continued on LIC 809-C] 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 [Continued from LIC 809] No toxic chemicals or poisons were accessible to clients.  Medications were labeled, as required, and stored in locked areas. No pools or bodies of water exist on the premises. Per Administrator Caccam, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. Fire extinguishers were serviced within the last 12 months. First aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA interviewed one (1) staff and (2) clients, and interviews did not reveal any licensing or regulatory concerns. LPA reviewed facility records. The files reviewed by LPA contained required documents, aside from two (2) staff files missing required health screenings and Tuberculosis testing. A deficiency was cited per California Code of Regulations 87411(f). Confidential records were stored in locked areas. A deficiency was cited during the inspection. An exit interview was conducted with Administrator Caccam to whom a copy of this report and the Licensee/Appeal Rights (LIC 9058) were provided. Their signature below confirms receipt of these documents.

Chronic/ intermittent diarrhea was noted in these documents. An interview with an external source revealed the concern of lack of incontinence care was discussed during resident council meetings. This source addressed this concern with management, but it was not addressed. Interviews with internal sources, including R1, revealed there were instances when R1 had to wait up to forty minutes to be assisted with brief changes. Each shift had two caregivers and one medication technician on duty. The two caregivers were assigned to respond to resident calls and assist residents with incontinence care. The medication technician was assigned to pass medications. These sources also corroborated that during mealtimes R1 had to wait until caregivers were available. Interviews revealed there were approximately six to seven residents who required assistance with feeding, which required both caregivers to assist those residents during mealtimes. Interviews consistently disclosed most of the residents in care required assistance with incontinence care. Although there were contradicting statements on if medication technicians, kitchen staff, and administrative staff assisted the caregivers, there was enough evidence to substantiate the allegation. 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 Administrator Caccam. An exit interview was conducted with Administrator Caccam, to whom a copy of this report, LIC 9099D, and Licensee/Appeals Rights (LIC 9058), were provided via email. An email read receipt confirmed the documents were received by the administrator.

Licensing Program Analyst (LPA) Sabel Martinez conducted a Case Management – Deficiencies visit. The LPA introduced himself and disclosed the purpose of the visit to Front Desk Manager Yasmin Perez and Activities Director Gabriela Ortiz. During a complaint investigation visit conducted on 9/26/2024, it was revealed Staff # 1 (S1) and Staff # 2 (S2) did not have approved background clearances. This was confirmed through a review of staff records and a review of the Department's Background Guardian system. This deficiency was cited in an LIC 809D form and a civil penalty of $1,000 was assessed in an LIC 421 BG form. A Plan of Correction POC was jointly formulated with Staff Perez. An exit interview was conducted with Perez and Ortiz to whom a copy of this report, a copy of the LIC 811 Confidential names list, LIC 421 BG, and Licensee Rights (LIC 9058), were provided.

The hospice agency was allegedly notified of this change in care. Interviews with said responsible party and hospice agency declined having any knowledge of R1’s transfer to a hospital, and only found out of the transfer once it had occurred. Differing statements from interviews with internal and external sources revealed R1 was R1 own responsible party, that R1 was no longer able to pay R1’s monthly fees, that R1 was transported to a hospital to be transferred to a skilled nursing facility, and that R1 was not provided a 30-day eviction notice for lack of payment. These sources also revealed R1 would be accepted back to the facility once R1 was accepted to the Assisted Living Waiver Program. Additionally, the facility was not able to produce records indicating R1 had a DPOA, nor that R1’s said responsible party had agreed for R1 to be transferred to a hospital. Based on evidence obtained, the allegation was Substantiated. The deficiency was cited in accordance with California Code of Regulations, Title 22, and listed on the LIC 9099D. A $1,000 civil penalty was assessed in an LIC 421IM form, for a repeat violation within the last twelve (12) months. A plan of correction was jointly formulated with Wellness Director Caccam. An exit interview was conducted with Caccam, to whom a copy of this report, LIC 9099D, LIC 811, LIC 421IM, and the Licensee/Appeals Rights (LIC 9058), were provided.

on behalf of R1’s family, for copies of records maintained by the facility relative to R1. R1’s responsible party signed an Authorization to Release Information, dated August 30, 2023, which was submitted to the facility along with the written request for copies of R1’s records. The investigation revealed that the request was received by the facility on September 15, 2023, and the licensee was made aware at that time. As of the time of today’s visit, no evidence is maintained or has been provided to conclude that the requested records have been provided to R1’s responsible party. Accordingly, the allegation is substantiated. This finding means that the preponderance of the evidence standard has been met and the allegation is valid. Deficiency is cited in accordance with California Code of Regulations, Title 22, Division 6, Chapter 8 and noted on the attached LIC 9099-D. An exit interview was conducted with Susan Caccam, Wellness Director, and a copy of this report and Licensee/Appeal Rights (LIC 9058) were provided to her at the conclusion of the visit. Susan Caccam’s signature on this report confirms receipt.

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.