197608878-12-12-2024-29-AS-KLOZ-DCG9NX-20241230223152

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608878
Report Date: 12/12/2024
Date Signed: 12/12/2024 02:25:30 PM

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
08/26/2024 and conducted by Evaluator Esther Cortez

COMPLAINT CONTROL NUMBER: 29-AS-20240826174337

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 Grennburg Business Office Manager		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Resident was inappropriately touched by staff

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Esther Cortez conducted a subsequent complaint visit to deliver final findings for the above allegation. During today’s visit, the LPA met with Business Office Manager II Michelle Greenburg and Director of Resident Services I, Lauria Gallagher and explained the reason for the visit.

On 08/26/2024, the Woodland Hills North Adult and Senior Care Regional Office received a complaint regarding sexual abuse. The complaint alleged Staff #1 (S1) sexually abused Resident #1 (R1) by touching R1’s vagina. The complaint was referred to the Community Care Licensing Division (CCLD) Investigations Branch (IB) and assigned to Investigator Christine Ferris.

On 08/28/2024, from 10:45am to 4:30pm, Licensing Program Analyst (LPA) Esther Cortez conducted an initial visit to investigate the allegation listed above. LPA Cortez arrived at the facility at 10:45am and met with Diane Lugar, Operations Specialist/Interim Administrator, and explained the reason for the visit. 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: 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-20240826174337

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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During the visit, the LPA interviewed the Interim Administrator at 11:00am, obtained copies of resident and staff records and other pertinent documents relevant to the investigation, toured the facility with Memory Care Director at 2:16pm and interviewed one staff at 3:30pm. The Operations Specialist/Interim Administrator was advised that the Community Care Licensing Division (CCLD) Investigations Branch (IB) Investigator Christine Ferris was assigned to investigate the allegation.

Investigator Ferris conducted interviews on 09/26/2024, from approximately 11:00am to 1:40pm, with the facility Operations Specialist/Interim Administrator, R1, Memory Care Director, residents, and staff; on 10/24/2024, from approximately 1:30pm to 2:15pm, with staff and a resident; and on 11/05/2024, at approximately 10:00am, with S1. In addition, Investigator Ferris reviewed Los Angeles County Sheriff’s Department Report #024-04236-2223-139 and Supplemental Report; and facility file documents related to R1 and S1.

According to the review of R1’s facility file documents, R1’s Physician Report, dated 09/14/2022, stated R1 is diagnosed with diabetes and heart failure, auditorily and visually impaired and wears hearing aids and glasses, is sometimes confused and disoriented, is able to follow directions and communicate needs, uses a walker and a wheelchair, and is non-ambulatory. R1’s placement in the assisted living portion of the facility was listed as 09/15/2022.

According to the Special Incident Report (SIR) submitted by the facility, on 08/17/2024, R1 told two facility staff that S1 touched R1. The staff reported this to the Memory Care Director (MCD), who then spoke to R1. R1 stated that S1 was changing R1’s brief (diaper) as R1 lay in bed. R1 stated S1 touched R1 while pointing to R1’s vagina area. The MCD asked R1 to explain, who stated S1 was rubbing R1. When asked if S1 could have possibly just been cleaning R1, R1 stated “no, I am not dumb, I can tell the difference”. The MCD asked if R1 told S1 to stop and R1 stated they said no to S1 and moved S1’s hand. R1 said S1 did it 2 or 3 more times. No one observed the incident. When the Operations Specialist/Interim Administrator interviewed R1, R1 repeated the same story. R1 was asked if R1 wanted to see a doctor or contact the police, R1 declined. R1’s resident representative was contacted about the incident. S1 was interviewed and denied the allegation. S1 was suspended pending investigation. On 08/27/2024, S1 was terminated.

Report will continue on LIC9099-C, 3rd page.

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-20240826174337

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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The Department’s investigation did not provide sufficient evidence to substantiate sexual abuse against S1. R1’s statement changed during the Department’s interview from what R1 initially reported to staff and the Los Angeles County Sheriff’s Department. There were no witnesses to the incident. Staff interviewed stated there were no safety concerns with S1 prior to the incident. The Los Angeles County Sheriff’s Department closed the case with no further action. S1 denied the allegation. Therefore, the allegation “Sexual Abuse: Resident #1 (R1) was inappropriately touched by Staff #1 (S1)” is deemed Unsubstantiated at this time.

Exit interview conducted, copy of this report 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)

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