197608878-3-21-2024-29-AS-DPEA-D4SVAK-20240429161605

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608878
Report Date: 03/21/2024
Date Signed: 03/21/2024 11:26:45 AM

Unsubstantiated

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
12/18/2023 and conducted by Evaluator Martha Arroyo

COMPLAINT CONTROL NUMBER: 29-AS-20231218160810

FACILITY NAME:	MEADOWBROOK AT AGOURA HILLS		FACILITY NUMBER:	197608878
ADMINISTRATOR:	JOEYVIC ALVARADO		FACILITY TYPE:	740
ADDRESS:	5217 CHESEBRO RD		TELEPHONE:	(818) 991-3544
CITY:	AGOURA HILLS	STATE: CA	ZIP CODE:	91301
CAPACITY:	185	CENSUS: 100	DATE:	03/21/2024
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Joeyvic Alvarado		TIME COMPLETED:	11:25 AM

ALLEGATION(S):

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Licensee retaliated against resident.
Facility staff failed to bathe resident.
Facility staff failed to clean resident's room.
Administrator does not respond to responsible party in a timely manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Martha Arroyo conducted a subsequent complaint visit to the above facility. The purpose of the visit is to deliver findings for the above allegations. The initial visit was conducted on 12/22/2023, and a subsequent visit was conducted on 02/29/2024 by LPA M. Arroyo. On today's visit, LPA Arroyo met with Executive Director (ED), Joey Alvarado. Entrance interview.

During the initial visit on 12/22/2023, at 10:35 a.m., LPA Arroyo conducted a tour of the facility to ensure there were no health and safety concerns, conducted interviews with the ED, one staff member, and one resident between 10:20 a.m. and 10:57 a.m., conducted a file review at 11:25 a.m., and obtained copies of pertinent documents. On 02/29/2024, LPA Arroyo conducted interviews with one staff member, eight residents, and two family members between 1:03 p.m. and 2:05 p.m., and obtained copies of pertinent documents.

Continued on LIC 9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Arroyo	TELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024

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 4

Control Number 29-AS-20231218160810

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: 03/21/2024

NARRATIVE

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Continued from LIC 9099...

It was alleged that licensee retaliated against resident. It was reported that shortly after Resident #1 (R1) had returned to the facility, R1’s family had received a notice that rates were being increased. Information obtained and records reviewed revealed that R1 was admitted to the facility on 08/31/2021. Records review revealed that R1 has had an annual increase for the last consecutive three (3) years, and R1 has been receiving notice for increase in monthly fees at about the same time every year at least sixty (60) days before the annual increase will take in effect for the following year. These notices were sent to both the resident as well as their responsible party. Furthermore, the annual monthly increase was not only sent to R1, but to many other residents currently residing at the facility. Based on the information obtained and reviewed, the Department does not have sufficient evidence to support the allegation of “licensee retaliated against resident”. Therefore, this allegation is being deemed Unsubstantiated at this time.

It was also alleged that facility staff failed to bathe resident. It was reported that Resident #2 (R2) was supposed to be bathed twice a week, but the facility neglected R2’s care. Records review of R2’s physician’s report dated 08/18/2021 indicated R2’s primary diagnosis is Alzheimer’s disease and has no capacity for self-care requiring assistance with all activities of daily living (ADL’s). Interviews conducted with staff revealed that showers are included for all memory care residents. All memory care residents have scheduled shower rotation twice a week and for R2, their shower rotation was scheduled for Tuesdays and Thursdays. Additionally, shower sheets are filled out for each resident after each resident has been showered. Additionally, during an interview with R2’s family member, they reported that R2 was always clean, and the facility was still taking care of R2 and bathing R2 twice a week while they were out of the facility. Furthermore, R2’s family member stated they were happy at the facility and had no concerns. Based on the information obtained and reviewed, the Department does not have sufficient evidence to support the allegation of “facility staff failed to bathe resident”. Therefore, this allegation is deemed Unsubstantiated at this time.

Continued on LIC 9099C...

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Arroyo	TELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20231218160810

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: 03/21/2024

NARRATIVE

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Continued from LIC 9099C...

It was also alleged that facility staff failed to clean resident's room. It was reported that facility did not clean R1’s room even after feces had gotten on the floor and was stepped on for days. Information obtained and records reviewed revealed that R1 and R2 shared a bedroom in the memory care unit. Interviews conducted with staff revealed that housekeeping is done once a week; however, it will be done more often if needed. Additionally, staff stated that although R1 was fairly independent, R1 had had a few incontinence accidents but did not report it to staff or allow staff to assist. This prompt staff to check R1’s and R2’s room occasionally and request housekeeping to come in and either clean or change the linens. Interviews conducted with residents revealed that housekeeping comes into their rooms, clean, change the bed sheets, and take out the trash. Additionally, residents added that housekeeping does their job by maintaining their rooms clean. Furthermore, during an interview with R1, R1 stated that housekeeping was being done a couple times a week as they were trying to keep the place clean and did not report having any concerns about the facility. Based on the information obtained and reviewed, the Department does not have sufficient evidence to support the allegation of “facility staff failed to clean resident’s room”. Therefore, this allegation is being deemed Unsubstantiated at this time.

It was further alleged that Administrator does not respond to responsible party in a timely manner. It was reported that the Reporting Party (RP) had contacted the Administrator regarding the 30-day notice, but the Administrator did not call the RP for several days and was not responding to RP’s messages. Information obtained during the course of the investigation revealed that the RP had emailed the Administrator on the evening of 12/03/2023 stating that had called the facility and left several voicemails for the Administrator to return their call. Records review revealed that the Administrator replied to the RP the following morning apologizing for not having access to the voicemails as they were sick and out of the office; however, the Administrator informed the RP that they were able to answer any questions they had via email. Additionally, the email interaction revealed that the Administrator was replying to RP’s emails the same day, if not the following day.

Continued on LIC 9099C...

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Arroyo	TELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 29-AS-20231218160810

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: 03/21/2024

NARRATIVE

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Continued from LIC 9099C...

Furthermore, interviews conducted with family members revealed that the Administrator is good at getting back to them and addressing their concerns in a timely manner. Based on the information obtained and reviewed, the Department does not have sufficient evidence to support the allegation of “Administrator does not respond to responsible party in a timely manner”. Therefore, this allegation is deemed Unsubstantiated at this time.

Exit interview. No citations issued. Report was reviewed with the ED and a copy was issued.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Arroyo	TELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024

LIC9099 (FAS) - (06/04)

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