197608878-3-8-2022-29-AS-JAPL-CCE3PX-20220310172617

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608878
Report Date: 03/08/2022
Date Signed: 03/08/2022 02:30:13 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
03/08/2021 and conducted by Evaluator Ashley Smith

COMPLAINT CONTROL NUMBER: 29-AS-20210308144820

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:	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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Unexplained bruising observed on residents

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. 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-20210308144820

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: Unexplained bruising observed on residents
It was alleged that residents in the memory care unit were obtaining bruising from an unknown source, presumably due to neglect or abuse. A review of internal facility documents revealed that Resident #1 (R1) was observed with unexplained bruising on 01/27/2021, 03/08/2021, and 03/14/2021. In addition, Resident #3 (R3) had unexplained bruising and/or a skin tear on 1/06/2021, 2/15/2021, and 03/08/2021. However, at the time these occurred, these incidents were documented and reported to management per protocol.

Information obtained from staff interviews revealed that most of the residents in the memory care unit had skin integrity issues and as a result, could sustain a bruise from accidentally hitting something, or as a side effect of a medication such as a blood thinner. Interviews revealed that some residents would easily bruise, and that it was not due to neglect or abuse. Staff claimed that even while being careful in providing care to a resident, they may develop a bruise or discoloration days later.

Staff reiterated that if a bruise or skin tear was observed, staff would document the wound and alert management. At this time, staff stated that they are completing a skin assessment form to document any new bruises or skin tears observed. Resident interviews revealed that residents believed they were treated with respect and denied claims that staff were either physically or verbally abusive. Staff claimed that in general, staff were observed treating residents appropriately and denied observing any abuse or neglect. Based on the information obtained, there is insufficient evidence to support the claim that due to neglect or lack of care, residents sustained unexplained bruising. 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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