197608878-9-11-2024-29-AS-KLOZ-D9J4CP-20240927185927

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608878
Report Date: 09/10/2024
Date Signed: 09/11/2024 09:29:20 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
08/27/2024 and conducted by Evaluator Esther Cortez

COMPLAINT CONTROL NUMBER: 29-AS-20240827001844

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: 106	DATE:	09/10/2024
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Diane Lugar/Jeff Labelle ED		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Facility is not preventing the spread of COVID-19.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Esther Cortez conducted a subsequent visit to investigate the allegation listed above. LPA Cortez arrived at the facility at 10:45 a.m., and the LPA met with Operation Specialist Diane Lugar and explained the reason for the visit. Executive Director Jeff Labelle joined the LPA and Operation Sepcialist mid visit.

On 08/28/2024, between 01:30 p.m. and 4:30 p.m., the LPA interviewed the Interim Administrator, one staff, toured the facility with Memory care director and obtained copies of pertinent documents relevant to the investigation. During today's visit the LPA conducted a file review, one (1) staff and four (4) resindent interviews.

Report will continue on LIC9099-C (2nd Page.)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther Cortez	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024

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-20240827001844

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: MEADOWBROOK AT AGOURA HILLS	FACILITY NUMBER: 197608878
	VISIT DATE: 09/10/2024

NARRATIVE

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On the allegation "Facility is not preventing the spread of COVID-19."; it is the concern of the reporting party that on August 16th, 2024, there was an outbreak of Covid-19, and that the facility is not testing the residents. It was further reported that the facility does not have any protocols in place and Covid-19 is spreading. To investigate the allegation the LPA conducted a tour of the facility, interviews, and file review. On 08/28/24, during a plant tour the LPA observed an adequate supply of Personal Protective Equipment (PPE), and Covid tests and staff informed the LPA the community can obtain additional supplies as needed. In addition, the LPA observed PPE stations outside resident rooms who were Covid positive to allow for staff to promptly don and doff PPE when entering and exiting those rooms. File review revealed that the community has an approved infection control plan in place. The community’s infection control plan does not require mass testing of the residents. The facility’s policies and procedures as it pertains to infection control are adequate. In addition, staff and resident interviews revealed that residents were informed that there were Covid positive cases at the community. Furthermore, staff shared with the LPA the letter that was sent on 08/16/2024 via a mass email blast to the residents and the resident families informing them that the community was experiencing multiple Covid-19 positive cases, that the communal dining and group activities had stopped, and infection control practices were shared. Staff interviews also revealed that residents that had been exposed or presented symptoms were tested for Covid-19 and isolated if tested positive. Lastly, interview with an LA’s public health nurse during today’s visit revealed that testing closed contacts is recommended however, mass testing is not required unless specifically asked for. Based on the information gathered, the above allegation is deemed unsubstantiated at this time.

Exit interview conducted and report issued.

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther Cortez	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024

LIC9099 (FAS) - (06/04)

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