197608878-3-8-2022-29-AS-JAPL-CCE43E-20220310174437

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608878
Report Date: 03/08/2022
Date Signed: 03/08/2022 02:35:38 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/12/2021 and conducted by Evaluator Ashley Smith

COMPLAINT CONTROL NUMBER: 29-AS-20210312142123

FACILITY NAME:	MEADOWBROOK AT AGOURA HILLS		FACILITY NUMBER:	197608878
ADMINISTRATOR:	KAWANA ANTHONY		FACILITY TYPE:	740
ADDRESS:	5217 CHESEBRO RD		TELEPHONE:	(818) 991-3544
CITY:	AGOURA HILLS	STATE: CA	ZIP CODE:	91301
CAPACITY:	185	CENSUS: 77	DATE:	03/08/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Joey Alvarado		TIME COMPLETED:	12:40 PM

ALLEGATION(S):

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Facility staff yell at resident
Facility staff do not ensure resident has water

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ashley Smith arrived unannounced for a subsequent complaint visit. The LPA met with Executive Director Joey Alvarado and explained the reason for the visit.

During the initial virtual on 03/15/2021, the LPA interviewed staff at 1:23pm and requested pertinent documents. During the 10/04/2021 visit, the LPA conducted a tour at 9:30 a.m., interviewed staff at 10:15 a.m., 10:37 a.m., 11:45 a.m., 11:57 a.m. and 3:30 p.m., interviewed residents at 11:50 a.m., and 11:55 a.m., and reviewed records at 3:00 p.m. During the 12/05/2021 visit, the LPA interviewed staff at 12:30 p.m., 12:50 p.m., 1:02 p.m., 1:30 p.m., and interviewed six residents from 1:40 p.m. – 2:10 p.m. On 03/07/2022 at 4:58 p.m., the LPA interviewed a family member of a resident. Today, the LPA interviewed seven residents from 9:55 a.m. – 10:15 a.m., and interviewed five staff members from 10:00 a.m. - 11:15 a.m.

CONT 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2022

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 29-AS-20210312142123

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: MEADOWBROOK AT AGOURA HILLS	FACILITY NUMBER: 197608878
	VISIT DATE: 03/08/2022

NARRATIVE

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Regarding the allegation: Facility staff yell at resident
It was alleged that staff yelled at residents. In particular, it was mentioned that staff yelled at Resident #1 (R1). Resident interviews revealed that residents feel comfortable residing in this facility and believe they are being treated well. Residents denied claims of verbal abuse from staff and stated that staff maintained appropriate relationships with the residents. Lastly residents had not observed or witnessed staff yelling at other residents. Staff denied claims that they observed their colleagues yelling or being verbally abusive towards residents. Staff believed that they were calm in their approach in working with all residents. Staff whom provided care to R1 claimed that at times, R1 would be combative and wanted staff to respond to their needs ‘right away’. However, staff claimed that all interactions with and observed with R1 were appropriate and respectful. Whereas R1 was unavailable for interview, information obtained from an interview conducted with a family member of R1 revealed insufficient evidence as to whether R1 was verbally abused. R1’s family member believed that R1 received adequate care and denied claims that R1 was yelled at. Based on the information obtained, there is insufficient evidence to support the claim that facility staff yell at residents. This allegation is deemed Unsubstantiated at this time.

Regarding the allegation: Facility staff do not ensure resident has water
It was alleged that staff failed to ensure residents had water. Resident interviews revealed that residents felt that staff were responsive if they called for assistance and mentioned that staff would check on them regularly. Residents communicated no concerns and claimed that staff checked to see if they needed water. The above-mentioned information was obtained for both independent residents and residents that required extensive assistance from staff. During the visit, the LPA observed that water was accessible to residents within arm’s reach. Staff claimed that they would conduct status checks on residents every 1-2 hours and although they could not force residents to consume liquid, they made sure that water and other liquids was within reach of residents whom required extensive assistance.

In particular, it was mentioned that staff failed to ensure that Resident #1 (R1) had water. Whereas R1 was unavailable for interview, information obtained from an interview conducted with a family member of R1 revealed that they believed that R1 received adequate care and denied hearing concerns regarding R1 not receiving water. Based on the information obtained, there is insufficient evidence to support the claim that staff failed to ensure that resident has water. This allegation is deemed Unsubstantiated at this time.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2022

LIC9099 (FAS) - (06/04)

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