197608878-6-11-2020-29-AS-JAPL-C7KV53-20211007160711

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608878
Report Date: 06/11/2020
Date Signed: 06/11/2020 01:39:14 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE. SUITE 200
GOLETA, CA 93117

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/09/2020 and conducted by Evaluator Ashley Smith

COMPLAINT CONTROL NUMBER: 29-AS-20200609154113

FACILITY NAME:	MEADOWBROOK AT AGOURA HILLS		FACILITY NUMBER:	197608878
ADMINISTRATOR:	VANESSA JEWELL		FACILITY TYPE:	740
ADDRESS:	5217 CHESEBRO RD		TELEPHONE:	(818) 991-3544
CITY:	AGOURA HILLS	STATE:	ZIP CODE:	91301
CAPACITY:	185	CENSUS: 111	DATE:	06/11/2020
		UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Vanessa Jewell, Executive Director		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Due to construction, residents are not afforded comfortable accomodations, as there is no seating available in common areas

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ashley Smith initiated an initial -10 day complaint investigation for the above allegation. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically at 9:35am with Executive Director Vanessa Jewell. Entrance interview conducted. During today's visit, the LPA interviewed staff at 9:40am, 9:49am, and 10:22am, and conducted a virtual tour of the Memory Care Unit at 10:22am.

Regarding the above allegation, the complainant alleged that due to construction, there is a lack of seating available for memory care residents. During today's complaint visit, the LPA conducted a virtual tour of the memory care unit at 10:22am. Due to construction, there is one common area blocked off. However, during the virtual tour, the LPA observed available seating in a dining room, an additional common area/parlor room, and outdoor courtyard.

CONT on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 06/11/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2020

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-20200609154113

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE. SUITE 200
GOLETA, CA 93117

FACILITY NAME: MEADOWBROOK AT AGOURA HILLS	FACILITY NUMBER: 197608878
	VISIT DATE: 06/11/2020

NARRATIVE

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Due to the circumstances surrounding COVID-19, seating is limited in the available common areas. However, even with construction taking place in the memory care unit, there is enough seating for the residents currently residing in memory care at this time.

Based on the information obtained, there is insufficient evidence to support the claim that due to construction, seating is limited for residents in the memory care unit. This allegation is deemed Unsubstantiated at this time.

Exit interview conducted. A copy of the report was emailed to the Executive Director for signature.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 06/11/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2020

LIC9099 (FAS) - (06/04)

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