197608878-9-21-2022-29-AS-DPEA-CJPV64-20220928160856

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608878
Report Date: 09/21/2022
Date Signed: 09/21/2022 08:09:19 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
10/08/2021 and conducted by Evaluator Kasandra Lopez

COMPLAINT CONTROL NUMBER: 29-AS-20211008085239

FACILITY NAME:	MEADOWBROOK AT AGOURA HILLS		FACILITY NUMBER:	197608878
ADMINISTRATOR:	MATAN BURSTYN		FACILITY TYPE:	740
ADDRESS:	5217 CHESEBRO RD		TELEPHONE:	(818) 991-3544
CITY:	AGOURA HILLS	STATE: CA	ZIP CODE:	91301
CAPACITY:	185	CENSUS: 87	DATE:	09/21/2022
		UNANNOUNCED	TIME BEGAN:	12:27 PM
MET WITH:	Joey Alvarado		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Staff #1 (S1) had inappropriate interactions with residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) KaSandra Lopez conducted a subsequent complaint visit to deliver the findings for the above listed allegation. During today’s visit, LPA met with Administrator Joey Alvarado and explained the reason for the visit.

On 10/08/2021, the Department received a complaint regarding Personal Rights. It was alleged that Staff #1 (S1) was having inappropriate interactions with residents in the facility. On 10/11/2021, the complaint was referred to Community Care Licensing Division’s (CCLD) Investigations Branch (IB) and Investigator Olivia Spindola was assigned to investigate. On 10/11/2021, LPA Lopez conducted the initial unannounced complaint inspection. The LPA met with Regional Director Joann Gange and explained the reason for the inspection. During the inspection, between 11:58 AM and 4:00 PM, the LPA conducted interviews with Ms. Gange, Business Office Manager Michelle Greenberg, Staff #2 (S2) and Staff #3(S3). The LPA also obtained copies of pertinent documents. Report continued on LIC 9099-C.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra Lopez	TELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

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 8

Control Number 29-AS-20211008085239

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: 09/21/2022

NARRATIVE

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During the inspection, Mrs. Gange contacted law enforcement due to information the LPA received during the investigation and an officer came to the facility during the inspection to speak with staff. A report number was provided. At the end of the inspection, the LPA informed Ms. Gange that a referral had been made to CCLD’s Investigations Branch.

On 10/28/2021, between 10:00 AM and 11:45 AM, Investigator Spindola conducted interviews with Business Office Manager Michelle Greenberg, S3, Staff #4 (S4), Resident #2 (R2), and Resident #3(R3).

On 11/12/2021, Investigator Spindola attempted to obtain a copy of a police report from the Los Angeles County, Malibu/Lost Hill Station, but they were unable to locate any records pertaining to this investigation.

On 12/13/2021 at approximately 1:00 PM, Investigator Spindola attempted to conduct a telephone interview with Staff #5 (S5) but they refused to discuss the complaint allegations.

On 12/28/2021 at 1:00 PM, Investigator Spindola conducted telephone interviews with Witness #1 (W1) family member of Resident #1 (R1) and Staff #6 (S6) at 3:00 PM.

On 12/30/2021 between 3:00 PM-5:30 PM, Investigator Spindola conducted telephone interviews with Staff #7 (S7), Staff # 8(S8), and former Administrator Maton Burstyn.

On 01/03/2021 at approximately 2:00 PM, Investigator Spindola conducted a telephone interview with Staff #1 (S1).

On 01/06/2022 at approximately 11:00 AM, Investigator Spindola conducted a telephone interview with Staff #9 (S9).

On 01/07/2022 between 11:00 PM and 12:00 PM, Investigator Spindola conducted in person interviews at facility with Resident #4 (R4), Resident # 5 (R5), and Resident #6 (R6). Investigator Spindola also conducted an interview with Resident #1 (R1) on this day, at their current residence.

On 05/03/2022 and 05/06/2022, LPA Lopez attempted to contact former Administrator Maton Burstyn but did not receive a returned call.

Additional records were also requested from the facility on 05/06/2022 by LPA Lopez.

Report continued on LIC 9099-C.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra Lopez	TELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 8

Control Number 29-AS-20211008085239

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: 09/21/2022

NARRATIVE

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During the investigation, record review revealed that approximately in October 2020, there was an internal investigation by the facility pertaining to Staff #1 (S1). Four staff members submitted written statements reporting inappropriate behaviors by S1 with facility residents. Staff #7 (S7) reported that Resident #6 (R6) stated S1 was their boyfriend, and Resident #5 (R5) stated that S1 called them on their phone several times. Staff# 4 (S4) reported seeing S1 remove their mask and kiss Resident #2 (R2) on the cheeks and forehead and tell R2 they loved them. R6 also reported to S4 that they were having an affair with S1 and that R6 and S1 kiss. Staff #9 (S9) reported that they observed S1 giving R5 and R6 massages on their inner thighs and they observed S1 give R2, R6, and R7 a kiss on the lips. Staff #10 (S10) reportedly seen S1 take off their mask and kiss Resident #7 (R7) on the lips. S10 also stated R3 is always calling for S1 at 3:00 AM in bed naked. S1 submitted a written statement regarding the allegations made against S1 dated 10/08/2020, in which, S1 denied giving their personal number to any residents, but admitted to giving R5 innocent kisses and friendly hugs, and “going the extra mile” for R2 because they demand the extra help and have given R2 kisses on their forehead. S1 also admitted to giving R4 and another female resident a foot massage. Record review reflected that there was no record of any disciplinary action being taken during this time. CCLD was also not notified of the internal investigation.

A written statement dated 06/16/2021, in file from Staff #11 (S11) states on approximately 05/27/2021, S11 witnessed S1 in the room of R6 caressing R6’s hand and reported it to S12 immediately.

Record review revealed an email dated 07/06/2021, to Michelle Greenberg from the family member of R1 stating that during the week of June 7^th that while R1 was in the bathroom, S1 had walked into R1’s room without knocking. S1 introduced themselves and stated they occasionally had breakfast with R1 and would come back later. When R1 exited the bathroom, they were visibly disappointed that they had missed S1. A few days later, when the family member visited with R1 they asked about S1. R1 stated that S1 would not be back and that S1 got caught in their room and ran out. The family member inquired about what they got caught doing but R1 replied only that S1 was caught in their room. A few days after that, the family member again inquired about S1. R1 stated S1 came in their room after they clocked out, when there was a knock at R1’s door. When R1 answered the door, S1 flew out the door past the person knocking. The family member inquired why S1 would do this, and R1 stated because S1 was “caught” in their room but would not explain what “caught” in their room meant.

Report continued on LIC 9099-C.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra Lopez	TELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 8

Control Number 29-AS-20211008085239

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: 09/21/2022

NARRATIVE

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The family member was unsettled about hearing this information and initially reported the incident to Michelle at the front desk and then reported to Administrator Matan Burstyn on 06/30/2021. They assured the family member they would look into it.

On 07/06/2021, S1 submitted a written statement to the facility admitting to having coffee with the R1 in their room but denied being inappropriate with the resident. Internals documents revealed that the facility obtained statements from six (6) staff members on 08/04/2021, inquiring if they saw or heard of any inappropriate behavior conducted with residents by S1. Five (5) of the staff members only reported hearing rumors of S1 acting inappropriately but did not observe anything themselves. One (1) staff member, S3, reported that S3 walked in Resident #8 (R8)‘s room to deliver an item and observed S1 sitting in R8’s room watching while R8 was pleasuring themselves. R3 also reported that another staff member S5 stated that they observed S1 standing in R2’s room masturbating and observed S1 change R3 into a red dress and sing to R3.

There is no record of the facility reporting this to Community Care Licensing or to law enforcement at this time.

Additionally, interviews conducted by Investigator Spindola revealed the following. In February or March 2021, S3 observed S1 sitting in a recliner of Resident #8 (R8) as R8 masturbated. Upon seeing S3, S1 grabbed their phone and pretended to be using it. S3 also reported seeing S1 leaving other resident rooms sweating profusely. During the interview with S3, they stated another staff, Staff #5 (S5) reported to S3 that they observed S1 in R2’s closet masturbating while R2 masturbating in bed. S3 stated they reported it to management several months later on 08/04/2021. Investigator Spindola attempted to interview S5 but they refused to be interviewed about the subject.

When interviewed, S4 stated they would see S1 excessively hugging female residents and kissing them on the face or forehead. S4 also reported that S1 closed the med-tech room with S4 alone in the room and stated S4 could make the room warm for them which made them uncomfortable. S4 stated after they fired S1, S1 would text S4 asking about work but S4 didn’t respond. Staff #6 (S6) recalled that on an unknown date during the first part of 2021, S6 observed S1 massaging R1’s legs and would come to see R1 all the time. On another occasion in either April or May 2021, S6 observed S1 kiss Resident #6’s (R6). R6 also told S6 that S1 would kiss R6 good bye and that S1 kisses R6 on the mouth. S6 stated they reported the incident to management and wrote a statement regarding it. Report continued on LIC 9099-C.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra Lopez	TELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

LIC9099 (FAS) - (06/04)

Page: 4 of 8

Control Number 29-AS-20211008085239

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: 09/21/2022

NARRATIVE

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Moreover, Staff #7 (S7) stated R6 told S7 that S1 was R6’s boyfriend and then later in the day a love letter was delivered to the front desk for S1 from R6. On this same day, Resident #5 (R5) demanded that staff provide R5 with S1’s phone number as they stated S1 called R5 three times and they had missed the calls. On a day when S7 was helping S1 put Resident #3 (R3) to bed, S7 stated they walked ahead of R3 to began to get the bed ready when S7 heard body rubbing sounds and R3 giggling. When S7 turned around, S7 saw S1’s body up against R3’s rear hip area as if S1 was "humping” R3. They both looked at S7 and were smiling as when teenagers get away with something. S7 stated they reported it to the Executive Director at that time.

During the interview with R2, R2 stated S1 would sit on their bed when R2 was lying on it and S1 would grab R2’s right hand and show R2 how to touch their vagina. R2 demonstrated to Investigator Spindola how S1 showed R2 how to touch their self by pointing to their vagina. R2 also pulled their pajama dress up and showed Investigator Spindola their bare legs and diaper and again pointed to their vagina area to show the Investigator how S1 taught R2 how touch their vagina. During the interview with R3, although R3 suffers from Dementia, R3 was able to tell the Investigator that S1 would come in their room and sing for R3. R3 also said S1 would put on R3’s "red dress" and S1 would sing and dance for R3 and put R3 to bed.

During the interview with Staff #8 (S8), they stated they did not observe S1 do anything inappropriate with any residents but was aware of the allegations by several staff. S8 stated in June 2021, S4 reported that S1 made S4 feel very uncomfortable in the med-tech room which S8 reported to HR.

During the interview with former Administrator Matan Burstyn, she stated that that when she became aware of the allegation made by S4 regarding S1 closing the door behind them in the med-tech room, she got HR involved. She also started doing an internal investigation and learned about the S1’s history. Burstyn said they suspended S1 but did not terminate S1 as they said it was unsubstantiated even though they caught S1 in resident rooms. Burstyn said they went all the way up the corporation's CEO as she was upset they were not protecting the resident's rights. Burstyn said they talked to S1 and S1 gave her a statement but a member of their Corporate office did not want to do anything about it. Burstyn said she threatened to call Adult Protective Services and that's when they fired S1. Burstyn added that sometime in 2020, S1 was caught kissing a resident which was documented in S1’s file. Burstyn said this incident happened, while Vanessa Jewel was the Executive Director.

Report continued on LIC 9099-C.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra Lopez	TELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

LIC9099 (FAS) - (06/04)

Page: 5 of 8

Control Number 29-AS-20211008085239

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: 09/21/2022

NARRATIVE

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During the interview with Staff #9 (S9), they stated between 2020 and 2021 they observed S1 on two occasions massage R4’s upper-inner thighs from her knees to their private part when walking into R4’s unlocked room. S9 stated S1 got nervous and made excuses without S9 asking any questions about what S1 was doing. S9 said they reported it to former Executive Director, Vanessa Jewel, but they told S9, “You’re crazy”. S9 also stated they observed S1 kiss R6 several times and saw S1 kiss R2 and R7 once.

During the interview with Resident #4 (R4), they stated S1 was gone due to something they were accused of doing and inquired if S1 was in trouble again. R4 denied S1 ever touching R4 inappropriately or being kissed by S1 but stated however, that S1 did give them showers and massaged their feet.

During the interview with Resident #5 (R5), R5 stated they were a “hugger” and R5 and S1 would hug. R5 also stated S1 would massage their legs and knees but denied having sex with S1.

During the interview with Resident #6 (R6), R6 refused to answer any questions about S1. R6 stated S1 did not do anything inappropriate and denied being kissed or massaged by S1.

During the interview with Resident #1 (R1) recalled S1 and stated S1 was a hugger. R1 could not recall if S1 ever kissed R1. R1 stated S1 helped R1 with their baths but did not touch R1. R1 stated S1 liked their coffee. R1 stated one day several staff came in their room and chased S1 out and they never saw S1 again. R1 stated S1 never did anything bad to them.

During the interview with S1, S1 initially denied ever being counseled regarding kissing female residents in October 2020, but eventually admitted that S1 was spoken to about not hugging or kissing any female residents by former Executive Director, Vanessa Jewel. S1 denied kissing or hugging any residents since October 2020. S1 also admitted to giving foot massages but denied massaging the legs. S1 stated they were trained when they first started working there that there was one resident who required back massages after their baths and this resident was the only one who S1 also massaged their legs. S1 stated they were suspended by Michelle Greenburg on 06/11/2021 and never returned back to work. S1 denied ever teaching any residents or watching any residents masturbate. S1 also denied ever masturbating in a resident closet while the resident masturbated. S2 denied ever changing R3 in a red dress and singing to R3 or rubbing themselves against R3’s hips. S1 also denied closing the door with S4 in the room or texting S4.

Report continued on LIC 9099-C.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra Lopez	TELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

LIC9099 (FAS) - (06/04)

Page: 6 of 8

Control Number 29-AS-20211008085239

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: 09/21/2022

NARRATIVE

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Based on interviews and record review conducted, there is sufficient to support S1 was having inappropriate interactions with residents at the facility, including R1, R2, R3, R4, R5, R6, and R7. Therefore, the allegation of S1 having inappropriate interactions with residents is deemed substantiated at this time.

Deficiencies regarding reporting requirements will be issued under separate cover.

Pursuant to the CA Code of Regulations and/or the Health and Safety code the following deficiencies are being cited. See LIC 9099-D.

Exit interview and report review with Administrator Joey Alvarado. A copy of the report and appeal rights were emailed.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra Lopez	TELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

LIC9099 (FAS) - (06/04)

Page: 7 of 8

Control Number 29-AS-20211008085239

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: 09/21/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 10/04/2022 Section Cited CCR 87468.1(a)(1)	1 2 3 4 5 6 7	87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	S1 was terminated from employment. The current administrator shall ensure all staff receive training pertaining to W&I Code Section 15630 and mandated reporting and submit proof to CCL by 10/04/2022.
	8 9 10 11 12 13 14	Based on record review and interviews, the licensee failed to comply with the section cited above, as S1 had multiple reported inappropriate interactions with R1, R2, R3, R4, R5, R6, and R7 which poses an immediate health, safety, and personal rights risk to residents in care.	8 9 10 11 12 13 14	The Administrator also stated moving forward, any male caregivers will have a witness with them when providing ADL care for female residents. The Administrator will put this in writing and submit to CCL by 10/04/2022.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra Lopez	TELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

LIC9099 (FAS) - (06/04)

Page: 8 of 8