197608878-2-20-2025-29-AS-KLOZ-DEC43X-20250228174529

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608878
Report Date: 02/20/2025
Date Signed: 02/20/2025 04:46:37 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
02/12/2025 and conducted by Evaluator Esther Cortez

COMPLAINT CONTROL NUMBER: 29-AS-20250212152447

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: 120	DATE:	02/20/2025
		UNANNOUNCED	TIME BEGAN:	11:25 AM
MET WITH:	Joeyvic Alvarado		TIME COMPLETED:	04:50 PM

ALLEGATION(S):

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Staff are not responding to resident's call buttons 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 Administrator Joey Alvarado and was explained the reason for the visit. Entrance interview conducted.

During today's inspection, between 11:30 a.m. and 4:00 p.m., the LPA interviewed four (4) staff, ten (10) residents, tested three (3) randomly selected resident's pendants, reviewed and obtained copies of pertinent documents relevant to the investigation

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: 02/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025

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-20250212152447

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: 02/20/2025

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 that in case of an emergency a resident can die due to pendant calls not being answered in a timely manner. It was further reported that on 02/09/25 resident 1 (R1) around 7:30 a.m. pressed their call button and no one went, R1 then called the front desk and left a message, and waited for an additional 30 minutes until someone went to their room. Interviews conducted with staff revealed that caregivers are primarily the ones that respond to the resident’s call buttons and try to respond as quickly as they can but MedTechs and other staff will assist as well with the pendant calls to ensure they are answered in a timely manner. However staff interviews revealed that even though it does not happen often, residents have waited over 15 minutes to be assisted, it all depends if they are short staffed and how busy they are. Interviews conducted with ten (10) randomly selected residents revealed that four (4) out of the ten (10) residents do not use their pendant button as they are independent. Two (2) residents revealed staff gets to them as timely as possible, and four (4) residents revealed that it can take staff a long time to respond to their pendant calls with some revealing that they have waited over 30 minutes for assistance. Additionally, a review of the pendant call log response times revealed that on 2/09/25, R1 did not have a registered pendant call around 7:30 a.m., however, R1 did have two (2) pendant calls that took over 25 minutes to respond to on that same date. Furthermore, the pendant call log revealed that in about 21 pendant calls from various residents on 02/09/25, residents waited over 20 minutes for assistance including 12 calls that were answered after 30 minutes of waiting. Based on the information gathered through interviews, and file review, 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).Civil penalty was 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: 02/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20250212152447

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: 02/20/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/28/2025 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	Licensee will submit a plan on how they will ensure residents pendant calls are answered in a timely manner. Licensee will provide plan to LPA via email by COB 2/28/2025. If training will be held, licensee will submit proof of training.
	8 9 10 11 12 13 14	Based on interviews, andrecords review, 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
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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.

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther Cortez	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025

LIC9099 (FAS) - (06/04)

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