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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608878
Report Date: 12/12/2024
Date Signed: 12/12/2024 05:59:29 PM

Document Has Been Signed on 12/12/2024 05:59 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 HILLSFACILITY NUMBER:
197608878
ADMINISTRATOR/
DIRECTOR:		JOEYVIC ALVARADOFACILITY TYPE:
740
ADDRESS:5217 CHESEBRO RDTELEPHONE:
(818) 991-3544
CITY:AGOURA HILLSSTATE: CAZIP CODE:
91301
CAPACITY: 185TOTAL ENROLLED CHILDREN: 0CENSUS: 122DATE:
12/12/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH: Business Office Manager II Michelle Greenberg TIME VISIT/
INSPECTION COMPLETED:
06:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Esther Cortez conducted an unannounced Case Management - Deficiencies inspection due to deficiencies observed during the investigation for Complaint control #29-AS-20240826174337 which were unrelated to the complaint allegation. the LPA met with Business Office Manager II Michelle Greenberg and Director of Resident Services I, Lauria Gallagher and explained the reason for the visit.

During the complaint investigation of complaint # 29-AS-20240826174337, the following deficiency was observed:

The Operations Specialist/Interim Administrator stated they have worked at the facility for a couple of months and work Monday through Friday from 9:00am to 9:00pm, however was not found to be finger printed cleared and associated to the facility per the Licensing Information System report and Guardian online system.
An Immediate $500 Civil Penalty is assessed today.

Citation issued, Immediate $500 Civil Penalty issued, exit interview, appeal rights given.
Kasandra LopezTELEPHONE: (818) 596-4343
Esther CortezTELEPHONE: (747) 230-2225
DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/12/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 12/12/2024 05:59 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/12/2024
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
87355(e) All individuals subject to a criminal record review ... shall prior to working, residing ... in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or (2)Request a transfer of a criminal record clearance This requirement is not met as
Deficient Practice Statement
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POC Due Date: 12/13/2024
Plan of Correction
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The licensee will submit a plan describing how they will ensure staff are fingerprint cleared and associated to the facility prior to working. Submit proof to CCL by 12/13/2024
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Kasandra LopezTELEPHONE: (818) 596-4343
Esther CortezTELEPHONE: (747) 230-2225

DATE: 12/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/12/2024

LIC809 (FAS) - (06/04)
Page: 2 of 2