197608878-9-4-2025-29-AS-KLOZ-DPUQVN-20251230113036

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608878
Report Date: 09/04/2025
Date Signed: 09/04/2025 04:20:07 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
04/11/2025 and conducted by Evaluator Esther Cortez

COMPLAINT CONTROL NUMBER: 29-AS-20250411132132

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: 139	DATE:	09/04/2025
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Joeyvic Alvarado		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff placed resident in the memory care unit without proper authorization

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Esther Cortez conducted a subsequent unannounced complaint visit to deliver findings for the above allegation. Upon arrival, LPA met with the Executive Director Joey Alvarado and explained the reason for the visit.

On 04/14/25, between 11:20 a.m. and 4:15 p.m., the LPA toured the memory care unit, interviewed the administrator, one (1) staff, one (1) resident, one (1) resident's authorized person, conducted a file review, and collected pertinent documents relevant to the investigation. It was determined further investigation was required prior to issuing findings. On 05/16/25, the LPA conducted interviews with R1’s authorized person and a family member telephonically.

Report will continue on LIC9099-C, 2nd page.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025

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

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 29-AS-20250411132132

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: 09/04/2025

NARRATIVE

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Regarding the allegation, “Staff placed resident in the memory care unit without proper authorization”; it is the concern of the Reporting Party (RP) that starting in December 2024, Resident 1 (R1) a resident of high intelligence, with no significant memory issues asked facility staff for a transfer from their memory care (MC) room to an assisted living (AL) room and facility staff denied their request. It was further alleged that R1’s emotional health has declined due to living in the memory care unit and a lack of socialization opportunity. R1 has no interest in attending memory care activities as they are unchallenging and uninteresting to them and has reported “a depression” that lasted a few days after “being allowed” to go into the assisted living side of the facility to do activities. Facility staff continue to defer to R1’s, Power of Attorney for health care, who states that R1 has "frontal temporal dementia" and needs memory care. Furthermore, it is alleged that R1 denies having dementia and has stated the dementia diagnosis has been determined by a neuropsychologist to be in error and they have in their possession a multipage cognitive assessment made on 8/13/24 by Dr. Robert Duff from Insight Neuropsychology stating R1 does not have "frontal temporal dementia" or any other dementia. To investigate this complaint LPA Cortez reviewed R1’s records and conducted interviews.

A review of R1’s Admission Agreement signed by R1’s POA and dated 07/31/24, revealed that R1 was admitted to the facility with a Care Authorized Representative who is their POA. File review revealed that R1 has a signed Advanced Health Care Directive and Durable Power of Attorney dated 06/2007, designating their POA for health care to make health care decisions for them in their name as authorized in the Directive, in the event they become incapacitated. As per the Directive, R1’s POA has the power and authority to make decisions as to personal care for R1, which includes making decisions relating to their personal care, but not limited to, determining where they will live, providing meals, and hiring and supervising household employees and other service providers. File review also revealed that R1 has a letter from a physician indicating R1 is not capable of making their own decisions regarding medical treatment or financial matters, dated 05/24/2024, and has a Determination of Incapacity, dated 09/04/2024, signed by a licensed physician indicating that R1 is incapacitated and unable to handle their own financial affairs.

A review of R1’s admitting physician’s report, dated 05/29/24, indicated R1’s primary diagnosis was listed as frontal temporal dementia. The report indicated R1’s mental condition as confused/disoriented when sundowns, has sundowning behavior, and R1 is not able to leave the facility unassisted. A review of R1’s Neuropsychological assessment, dated 08/13/24, revealed that R1 underwent a neuropsychological assessment on 07/05/24, to evaluate their cognitive function. Report will continue on LIC9099-C, 3rd page.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 29-AS-20250411132132

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: 09/04/2025

NARRATIVE

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According to the records the clinical Neuropsychologist Licensed Psychologist concluded that there was little current evidence to suggest that R1 has frontotemporal degeneration that would lead to dementia. A review of R1’s most recent physician’s report, dated 03/13/25, indicated R1’s primary diagnosis as Frontotemporal Dementia. The report indicated R1 is not able to leave the facility unassisted.

An interview conducted with the current Administrator Joey Alvarado revealed that they were not working at the facility when R1 was placed at the facility but is aware that R1 was placed in the MC unit when admitted to the facility due to their frontal temporal dementia diagnosis, Drs. recommendation, and upon R1’s POA request due to safety concerns. R1 sent them an email back in February from his psychotherapy that they do not have dementia, however R1’s Physician’s report (LIC602) indicated Dementia. She had a new physician come out to the community and assessed R1 to determine if R1 could be placed in AL. Dr. Lefferman saw R1, diagnosed R1 with Frontotemporal Dementia and suggested they could try placing R1 in AL during the day and see how it went. The community is willing to place R1 in Assisted Living when they have clearance from the doctor but have safety concerns, concerned of R1 eloping due to R1’s diagnosis and POA’s voiced concerns, and do not want to be liable if any incident occurs if R1 is placed in AL when the POA requested for R1 to be placed in MC. The Administrator stated that R1’s POA told them that the moment they move R1 to AL, R1 will leave and they will lose R1. The Administrator further revealed that R1 is very lucid, is aware, has not shown any exit seeking or aggressive behavior, is not being provided with any care other than medication management, although R1 does forget things, and there is no receptionist at night to monitor the front door if the resident left.

Interviews conducted with R1’s POA and family members confirmed they placed R1 in the memory care unit due to safety concerns and R1 being diagnosed with frontotemporal dementia. They voiced concerns about the safety of R1 and the other residents if R1 gets placed in assisted living due to numerous previous incidents that had happened during the span of 6 months and are worried that R1 will have access to items that can pose a danger to them or that R1 will elope.

On the allegation “Staff placed resident in the memory care unit without proper authorization,” information obtained from record review and interviews conducted revealed R1 was placed in the memory care unit upon R1’s POA request who has the authority to determine where R1 resides per the signed Advanced Health Care Directive. The information and evidence obtained during the Department’s investigation did not sufficiently support the allegation, therefore, the allegation is deemed Unsubstantiated at this time. Exit interview conducted. A copy of the report and appeal rights provided.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025

LIC9099 (FAS) - (06/04)

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