197608878-12-12-2024-29-AS-KLOZ-DCG9ED-20241230221809

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608878
Report Date: 12/12/2024
Date Signed: 12/12/2024 06:14:06 PM

Substantiated

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
12/04/2024 and conducted by Evaluator Esther Cortez

COMPLAINT CONTROL NUMBER: 29-AS-20241204122034

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: 122	DATE:	12/12/2024
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Michelle Business Manager Officer		TIME COMPLETED:	06:15 PM

ALLEGATION(S):

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Staff are not responding to resident's call button in a timely manner

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Esther Cortez conducted an unannounced initial 10-day complaint visit for the above allegation. Upon arrival, LPA met with the Michelle Greenburg Bussiness Office Manager, and Lauria Gallagher Director of Resident Service and was explained the reason for the visit. Entrance interview conducted.

During today's inspection, between 01:45 p.m. and 6:00 p.m., the LPA interviewed four (4) staff, two (2) residents, and tested a resident's pendant.

Report will continue on LIC9099-C, 2nd page.

Substantiated

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: 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.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 29-AS-20241204122034

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: 12/12/2024

NARRATIVE

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On the allegation, "Staff are not responding to resident's call button in a timely manner"; it is the concern of the reporting party (RP) that resident 1’s (R1’s) pendant that they push for help is not being answered promptly consistently. RP revealed that R1 has waited 40 minutes to an hour for help. Interviews conducted with staff revealed that caregivers are the ones that respond to the resident’s call buttons and try to respond as quickly as they can; however, if the caregivers are assisting other residents, residents have waited over 15 minutes to be assisted. Staff revealed that residents have also waited over 30 minutes for assistance. Interviews conducted with two (2) residents revealed that they use the pendant for assistance and there have been occasions where they had to wait over 30 minutes, and it has happened constantly. Additionally, a review of the pendant call log response times revealed that 26 times that pendants were pressed on 12/01/2024, residents waited over 30 minutes. Furthermore, a resident had pressed their pendant during the interview with the LPA and after waiting over 30 minutes the LPA left and staff had not responded to the resident’s pendant. Based on the information gathered through interviews, file review, and observation the allegation Staff does not respond to resident's call button in a timely manner is deemed Substantiated at this time.

Pursuant to Title 22, California Code of Regulations (CCR), the following deficiency is cited (refer to LIC 9099-D).

Citations were issued. Exit interview was conducted and a copy of the report and Appeal Rights were issued.

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

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 29-AS-20241204122034

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/12/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 12/26/2024 Section Cited CCR 87468.2(a)(4)	1 2 3 4 5 6 7	87468.2(a)(4)residents…shall have all of the following personal rights: To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs.This requirement is not met as evidence by:	1 2 3 4 5 6 7	Business Office Manager agreed to have an in service with all staff regarding how to respond resident calls in a timely manner and will also develop a plan to ensure that pendant calls are answered in a timely manner. Will submit proof of inservice and plan to CCL by 12/26/2024.
	8 9 10 11 12 13 14	Based on interviews,records review, and observation the licensee did not comply with the section cited above as Staff did not respond to residents calls for assistance in a timely manner, which poses a potential health and safety risk to residents in care.	8 9 10 11 12 13 14
	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: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther Cortez	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	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

LIC9099 (FAS) - (06/04)

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