197608878-8-31-2023-29-AS-DPEA-CW3MTG-20230927095330

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608878
Report Date: 08/31/2023
Date Signed: 08/31/2023 11:52:41 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
08/24/2023 and conducted by Evaluator Martha Arroyo

COMPLAINT CONTROL NUMBER: 29-AS-20230824164138

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: 96	DATE:	08/31/2023
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Joeyvic Alvarado		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Facility did not allow residents to have visitors.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Martha Arroyo conducted an initial 10-day complaint visit for the above allegation at 9:30 a.m. Upon arrival, the LPA was greeted by the front desk clerk. LPA met with the Health and Wellness Director (HWD), Alex Alvarado and at this time the reason for the visit was explained. The Administrator arrived shortly after. Entrance interview conducted.

During today's visit, at 9:42 a.m., the LPA along with the HWD conducted a plant tour to ensure there were no health and safety concerns, conducted interviews with the Administrator and two (2) staff between 9:36 a.m. and 10:30 a.m., and conducted a file review and obtained copies of pertinent documents relevant to the investigation at 10:05 a.m.

(Report Continued on LIC 9099C...)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Arroyo	TELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023

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-20230824164138

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: MEADOWBROOK AT AGOURA HILLS	FACILITY NUMBER: 197608878
	VISIT DATE: 08/31/2023

NARRATIVE

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(Report Continued from LIC 9099...)

Regarding the allegation: facility did not allow residents to have visitors. It was reported that family members were not allowed to visit residents due to a recent covid outbreak. Record review of facility’s Visitor Log for August 2023 revealed family members were visiting the residents on a daily basis after the covid outbreak had been reported to both the Department of Public Health and resident’s family members. The Administrator stated family members were advised to make appointments to have visitation in an outdoor setting only if and when either the family member and/or resident were not displaying any type of symptoms. Additionally, the Administrator provided LPA with copy of email with letter sent to all family members stating the memory care unit had an active outbreak and also outlined visitation guidelines for all visitors if they still chose to visit residents in person. Interviews conducted with staff revealed that visitation in the memory care unit was still being conducted in the patio area by appointment only as long as family members or residents were not displaying flu-like symptoms, the family members were advised to either call, facetime, or zoom in the meantime in order to keep both residents and visitors safe. Furthermore, the facility continued to allow visitation in the memory care unit throughout the Covid outbreak. Based on the information obtained and reviewed, the Department does not have sufficient evidence to support the allegation of “facility did not allow residents to have visitors”. Therefore, this allegation is being deemed Unsubstantiated at this time.

Exit interview conducted. No citations issued. A copy of the report was issued.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Arroyo	TELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023

LIC9099 (FAS) - (06/04)

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