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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608878
Report Date: 10/20/2020
Date Signed: 10/20/2020 05:23:45 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, 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
08/27/2020 and conducted by Evaluator Ashley Smith
COMPLAINT CONTROL NUMBER: 29-AS-20200827144755
FACILITY NAME:MEADOWBROOK AT AGOURA HILLSFACILITY NUMBER:
197608878
ADMINISTRATOR:LORRIE MARCOTTFACILITY TYPE:
740
ADDRESS:5217 CHESEBRO RDTELEPHONE:
(818) 991-3544
CITY:AGOURA HILLSSTATE: ZIP CODE:
91301
CAPACITY:185CENSUS: 100DATE:
10/20/2020
UNANNOUNCEDTIME BEGAN:
04:30 PM
MET WITH:Kawana AnthonyTIME COMPLETED:
05:15 PM
ALLEGATION(S):
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Licensee charged an authorized fee
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ashley Smith conducted a subsequent complaint inspection. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s investigation was conducted telephonically with Business Office Manager Michelle Greenberg, Regional Director of Operations JoAnne Guzman, and Executive Director Kawana Anthony. During the 8/27/2020 visit, the LPA interviewed staff at 3:22pm and 3:25pm and requested documents.

Regarding the allegation, it was alleged that the community issued an unauthorized fee increase due to COVID-19. Staff interviews and documentation review confirmed that residents were allegedly informed at the end of June 2020 that a $250 COVID-fee would be added to monthly billing statements beginning September 1, 2020. The LPA obtained an invoice, which revealed a separate itemized fee of $250 with the attached description of ‘Covid-19 Fee’.

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley SmithTELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2020
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 3
Control Number 29-AS-20200827144755
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: 10/20/2020
NARRATIVE
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Per regulation, licensees shall not charge non-reoccurring lump-sum assessments; instead, increases shall be to the monthly rate distributed over a 12-month period. Documentation review reveals that the Covid-19 fee is separated out of the monthly rate, and allegedly over a four-month period. Based on the information obtained, there is sufficient evidence to support the claim that the licensee charged an unauthorized fee. This allegation is deemed Substantiated at this time.

The following deficiencies were observed (See LIC 9099-D) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report was provided via email for signature, along with appeal rights.
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley SmithTELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20200827144755
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/20/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
10/23/2020
Section Cited
HSC
1569.655(b)
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Increase in fee rates for elderly residents. No licensee shall charge nonrecurring lump-sum assessments... In lieu of the lump-sum payment, all increases in rates shall be to the monthly rate amortized over a 12-month period.
This requirement is not met as evidenced by:
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The Administrator has agreed to do the following:
1. A Plan of Action will be created, detailing how the facility will correct the situation. Plan of Action will be submitted to CCLD no later than 10/23/2020.
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Based on the information obtained through interview and record review, the licensee did not comply with the section cited above, as the fee increase was specified for only a four month period and was separate of the monthly rate, which poses a potential personal rights risk to residents in care.
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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: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley SmithTELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2020
LIC9099 (FAS) - (06/04)
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