565850066-2-18-2025-29-AS-KHEN-DE8VMV-20250225153411

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565850066
Report Date: 02/18/2025
Date Signed: 02/18/2025 04:02:48 PM

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
08/02/2024 and conducted by Evaluator Kelly Dulek

COMPLAINT CONTROL NUMBER: 29-AS-20240802172103

FACILITY NAME:	MEADOWGLADE, THE		FACILITY NUMBER:	565850066
ADMINISTRATOR:	HELO, NICOLE		FACILITY TYPE:	735
ADDRESS:	6446 MEADOWGLADE DR		TELEPHONE:	(805) 530-5301
CITY:	MOORPARK	STATE: CA	ZIP CODE:	93021
CAPACITY:	6	CENSUS: 4	DATE:	02/18/2025
		UNANNOUNCED	TIME BEGAN:	01:46 PM
MET WITH:	Shadi Bateni, Program Director		TIME COMPLETED:	04:10 PM

ALLEGATION(S):

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Staff are not providing adequate food service to residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kelly Dulek conducted a subsequent complaint investigation with the continuing the investigation for the above allegation. Upon arrival, LPA met with Program Director Shadi Bateni. Entrance interview conducted.

LPA Zabel Chochian conducted an initial complaint visit on 08/07/2024. During that visit, the LPA along with Administrator conducted a physical plant tour to ensure there were no health and safety concerns at approximately 3:45pm. Facility food service area was observed. During today’s visit, LPA Dulek interviewed Program Director at 01:52PM, toured the facility food service areas with Program Director at 01:58PM, LPA took photos of the facility’s weekly menu, and LPA interviewed staff and clients from 02:02PM to 03:00PM. The following was then determined:

Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:	DATE: 02/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2025

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-20240802172103

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: MEADOWGLADE, THE	FACILITY NUMBER: 565850066
	VISIT DATE: 02/18/2025

NARRATIVE

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It was alleged that the facility does not provide adequate food service, as food is prepared off site and appropriate food has not been provided to clients at this facility. LPA observed that this location only contains a kitchenette and LPA was informed the larger house, which is not licensed by CCLD, does have a full kitchen and chefs employed. Chefs from the other house do cook food, which is then delivered to this location for lunch and dinner as well as some breakfast items. LPA observed this location does have ample snacks and breakfast items available. LPA reviewed the facility’s menu, which clients had reviewed and chosen the specific meal items they wanted each day. Clients are also able to order their own food or grocery items and request an alternate meal if they so choose. Program Director showed the LPA a group chat between facility staff and chefs indicating the clients’ daily food choices and dietary needs. Interview revealed that upon admission, clients are able to fill out a form which indicates food preferences, dietary restrictions, and any allergies. Clients stated that admissions also conducted an interview and had further reviewed these needs with the clients. Staff and clients at the facility both indicated that their preferences and dietary needs had been discussed at length at the facility. However, some clients expressed concern that the off-site chefs seemed to be unaware of the information provided. Clients interviewed did indicate all 3 (three) meals and snacks have been provided daily. All persons interviewed indicated there has never been a time when a meal or snack was not provided. The information obtained during the investigation did not include evidence sufficient to corroborate the allegation. Although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time.

No citations issued. Exit interview conducted. A copy of today’s report was provided.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:	DATE: 02/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2025

LIC9099 (FAS) - (06/04)

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