197608878-4-9-2025-29-AS-KLOZ-DG8W2J-20250430165424

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608878
Report Date: 04/09/2025
Date Signed: 04/09/2025 05:56:40 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
04/08/2025 and conducted by Evaluator Esther Cortez

COMPLAINT CONTROL NUMBER: 29-AS-20250408090835

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: 135	DATE:	04/09/2025
		UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Joeyvic Alvarado		TIME COMPLETED:	06:00 PM

ALLEGATION(S):

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Facility failed to provide resident records to resident and/or their authorized person

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 10:50 a.m. and 5:30 p.m., the LPA interviewed the administrator, conducted a file review, and collectected pertinent documents relevant to the investigation.

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: 04/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2025

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-20250408090835

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: 04/09/2025

NARRATIVE

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Regarding the allegation "Facility failed to provide resident records to resident and/or their authorized representative," the concern raised by the reporting party is that, on 03/25/25, a request was made by Resident #1 (R1) or their authorized representative for R1's medical and billing records, and that the facility did not provide the requested records.

An interview with the Administrator clarified that, on 03/25/25, the facility received a subpoena for R1's medical and billing records, which included a specified deadline of two business days for submission. The requested records were faxed to the number listed on the subpoena on 03/28/25. The Administrator further stated that, prior to releasing the records, they contacted the point of contact listed on the subpoena on 03/28/25. During this communication, the Administrator informed the individual that the records would be faxed shortly and explained that the delay was due to the need for review by the legal department before the records could be released. Additionally, the Administrator revealed that on 04/08/25, the requested documents were resent by fax (in multiple transmissions due to fax issues) to ensure receipt. The Administrator noted that they had not been contacted regarding any missing documents.

A file review confirmed that the community had received a record request for R1's medical and billing records. The LPA observed a Fax Transmission page dated 03/28/25, indicating that 228 pages were faxed to the number listed on the record request, addressed to the point of contact with the comment "requested items." Furthermore, the LPA observed six additional Fax Transmission pages, each dated 04/08/25, showing that a total of 208 pages were faxed to the fax number listed on the record request.

An interview with the point of contact listed on the record request, on 04/09/25, revealed that they had received R1's medical records on 04/08/25, but were still awaiting the billing records. The point of contact further stated that they had spoken to a representative at the facility, who informed them they were waiting to close out March and then the billing records would be sent. Based on the information gathered, the community provided and/or will provide the requested documents regarding R1, and are not denying production of any requested information, therefore, the above allegation is deemed unsubstantiated at this time.

Exit interview conducted and report issued.

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther Cortez	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2025

LIC9099 (FAS) - (06/04)

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