197608878-10-4-2021-29-AS-JAPL-C7KVRM-20211007164011

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608878
Report Date: 10/04/2021
Date Signed: 10/04/2021 04:32:34 PM

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
09/21/2020 and conducted by Evaluator Ashley Smith

COMPLAINT CONTROL NUMBER: 29-AS-20200921094046

FACILITY NAME:	MEADOWBROOK AT AGOURA HILLS		FACILITY NUMBER:	197608878
ADMINISTRATOR:	LORRIE MARCOTT		FACILITY TYPE:	740
ADDRESS:	5217 CHESEBRO RD		TELEPHONE:	(818) 991-3544
CITY:	AGOURA HILLS	STATE: CA	ZIP CODE:	91301
CAPACITY:	185	CENSUS: 91	DATE:	10/04/2021
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Michelle Greenberg		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Insufficient staffing to meet residents' needs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ashley Smith arrived unannounced for a subsequent complaint visit. The LPA met with Michelle Greenberg and explained the reason for the visit.

During the initial visit on 09/22/2020, the LPA interviewed staff at 10:28 a.m. and requested documents. On 10/02/2020, the LPA interviewed staff at 2:53 p.m. and 3:40 p.m., and on 11/05/2020 at 3:59 p.m. On 9/22/2020, the LPA interviewed representatives from a collateral agency on 09/22/2021 at 10:50 a.m. and 11:37 a.m., and on 9/23/2020 at 9:12 a.m. LPA Desaree Perera interviewed residents' responsible parties on 10/05/2020 at 1:12 p.m., 1:44 p.m. and 2:37 p.m.

Today, the LPA conducted a tour at 9:30 a.m., interviewed staff at 10:15 a.m., 10:37 a.m., 11:45 a.m., 11:57 a.m. and 3:30 p.m., interviewed residents at 11:50 a.m., and 11:55 a.m., and reviewed records at 3:00 p.m.

Substantiated

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: 10/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2021

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-20200921094046

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: 10/04/2021

NARRATIVE

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Regarding the allegation: Insufficient staffing to meet residents' needs.
It is alleged that this facility does not have enough staff. Interviews conducted revealed that out of the thirty-two (32) memory care residents, most of the residents require extensive assistance with care needs (ie. bathing, dressing, incontinent challenges) and at least ten (10) of the residents require a two-person assist for transfers and care. Interviews confirmed that due to lack of staff, staff stated that they regularly transfer residents alone; if staff were to wait for assistance, residents have to wait longer than usual to receive care. Staff claim that they are encouraged to ask for additional assistance for transfers, but chronic under-staffing issues makes this option challenging. Additional interviews with collateral agencies and visitors revealed that individuals have either had to wait an extended period of time or had to locate staff to receive assistance. Whereas it was communicated that there should be three (3) care staff on shift, plus a medication technician, yet there is often only two care staff available to assist with resident care. This facility also relies on agency staff to fill in, yet it was communicated that the staff will often call off. Interviews conducted with management revealed that they are aware that the facility needs additional staffing and is in the process of hiring additional caregivers.

Based on the information obtained, there is sufficient evidence to support the claim that there is insufficient staffing. This allegation is deemed Substantiated at this time.

Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 9099-D):

Exit interview conducted, today's reports and appeal rights were reviewed and issued.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2021

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20200921094046

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/04/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 10/06/2021 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	87411(a) Personnel Requirements – General. Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee has agreed to do the following: 1. Submit a staffing plan, demonstrating how staff numbers will be sufficient to meet the needs of all residents. Plan should also detail how the facility will appropriately assist with residents whom require two staff assistance. Submit Plan by 10/06/2021, end of day
	8 9 10 11 12 13 14	Based on interview and records review, the licensee did not comply with the section cited above, as the facility is experiencing staffing challenges, which poses an immediate health and safety risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 5

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
09/21/2020 and conducted by Evaluator Ashley Smith

COMPLAINT CONTROL NUMBER: 29-AS-20200921094046

FACILITY NAME:	MEADOWBROOK AT AGOURA HILLS		FACILITY NUMBER:	197608878
ADMINISTRATOR:	LORRIE MARCOTT		FACILITY TYPE:	740
ADDRESS:	5217 CHESEBRO RD		TELEPHONE:	(818) 991-3544
CITY:	AGOURA HILLS	STATE: CA	ZIP CODE:	91301
CAPACITY:	185	CENSUS:	DATE:	10/04/2021
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Michelle Greenberg		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Residents are not getting meals.
Facility is not well-lit.

INVESTIGATION FINDINGS:

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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: 10/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 29-AS-20200921094046

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: 10/04/2021

NARRATIVE

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Regarding the allegation: Residents are not getting meals.
It was alleged that due to lack of staffing, residents were not receiving meals and were not being fed. Interviews conducted revealed that even during the times that the Memory Care unit was quarantined due to COVID-19 restrictions, the dining staff continued to deliver food to the Memory Care unit. It was also communicated that if there were residents whom were positive with COVID-19, staff had to ensure that they were hydrated and fed because a side effect of the COVID-19 diagnosis was loss of appetite. Hence, staff ensured that residents continued to receive meals. Lastly, staff stated that many residents needed to be monitored while eating, so staff were regularly monitoring food intake. During today’s visit, the LPA observed that the Memory Care residents received both breakfast, lunch, and midday snacks. Based on the information obtained, there is insufficient evidence to support the claim that the residents were not getting meals. This allegation is deemed Unsubstantiated at this time.

Regarding the allegation: Facility is not well-lit.

It was alleged that the facility, specifically in the Memory Care Unit, was not well lit. The LPA toured the Memory Care facility at approximately 9:30 a.m. and observed all areas to be well lit. The LPA observed that there is motion sensor lighting throughout the memory care unit but as long as there is a person in the general vicinity, the lights will stay on. As such, if someone stepped into a dimly lit area, the presence of a person would cause the lights to turn on. Interviews conducted could not corroborate the claim that parts of the facility were not well lit. The LPA did not observe dim areas while at the facility. Based on the information obtained, there is insufficient evidence to support the claim that the facility is not well lit. This allegation is deemed Unsubstantiated at this time.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2021

LIC9099 (FAS) - (06/04)

Page: 5 of 5