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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608878
Report Date: 10/15/2025
Date Signed: 10/15/2025 10:18:07 PM

Substantiated


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
10/06/2025 and conducted by Evaluator Valeria Conway
COMPLAINT CONTROL NUMBER: 29-AS-20251006091242
FACILITY NAME:MEADOWBROOK AT AGOURA HILLSFACILITY NUMBER:
197608878
ADMINISTRATOR:JOEYVIC ALVARADOFACILITY TYPE:
740
ADDRESS:5217 CHESEBRO RDTELEPHONE:
(818) 991-3544
CITY:AGOURA HILLSSTATE: CAZIP CODE:
91301
CAPACITY:185CENSUS: 140DATE:
10/15/2025
UNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Joeyvic AlvaradoTIME COMPLETED:
05:35 PM
ALLEGATION(S):
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Staff failed to treat resident with dignity or respect
Staff failed to meet residents incontinent needs while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Valeria Conway conducted an unannounced 10-day initial complaint visit to investigate the allegations listed above. Upon arrival LPA met with the Executive Director (ED), Joeyvic “Joey” Alvarado, and explained the reason for the visit.

During today’s visit, between 10:55 A.M.– 4:45 P.M., LPA and administrator toured the physical plant to ensure there are no health and safety concerns. Additionally, LPA interviewed the ED and staff members, obtained and reviewed pertinent documents relevant to the investigation. The LPA reviewed all documents obtained, conducted telephonic interviews with additional credible witnesses. The following was then determined:

Conitnued on LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2025
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 6
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
10/06/2025 and conducted by Evaluator Valeria Conway
COMPLAINT CONTROL NUMBER: 29-AS-20251006091242

FACILITY NAME:MEADOWBROOK AT AGOURA HILLSFACILITY NUMBER:
197608878
ADMINISTRATOR:JOEYVIC ALVARADOFACILITY TYPE:
740
ADDRESS:5217 CHESEBRO RDTELEPHONE:
(818) 991-3544
CITY:AGOURA HILLSSTATE: CAZIP CODE:
91301
CAPACITY:185CENSUS: 140DATE:
10/15/2025
UNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Joeyvic AlvaradoTIME COMPLETED:
05:35 PM
ALLEGATION(S):
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Resident was left in soiled diaper for extended period of time
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Valeria Conway conducted an unannounced 10-day initial complaint visit to investigate the allegations listed above. Upon arrival LPA met with the Executive Director (ED), Joeyvic “Joey” Alvarado, and explained the reason for the visit.

During today’s visit, between 10:55 A.M.– 4:45 P.M., LPA and administrator toured the physical plant to ensure there are no health and safety concerns. Additionally, LPA interviewed the ED and staff members, obtained and reviewed pertinent documents relevant to the investigation. The LPA reviewed all documents obtained, conducted telephonic interviews with additional credible witnesses. The following was then determined:

Continued on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 29-AS-20251006091242
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: 10/15/2025
NARRATIVE
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Continued from LIC 9099

Regarding allegation “Resident was left in soiled diaper for extended period of time” it was alleged that R1 was left in a soiled diaper for more than ten (10) hours. Interviews conducted reflected the R1’s family was notified by the facility ED that R1 had not been checked since 5:45 P.M. on the evening of 09/29/2025. Information gathered during the course of the investigation reflected that, the ED made a typographical error when corresponding with R1’s family and inadvertently stated P.M. vs A.M. Per the ED, the information was inaccurate as the night shift begins at 10:00 P.M. and ends at 6:00 A.M. the following day. Based on the above information gathered although the allegations may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the allegations “Resident was left in soiled diaper for extended period of time” is deemed unsubstantiated at this time.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 29-AS-20251006091242
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: 10/15/2025
NARRATIVE
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Continued from LIC 9099

It was alleged that “Staff failed to treat resident with dignity or respect”. It was reported that in March 2025, Staff #1 (S1) intentionally fed Resident #1 (R1) dog food, allegedly as a joke. After receiving a formal complaint and speaking to the Reporting Party (RP), LPA reviewed the facility’s history and determined that on 04/09/2025 a Case Management (CM) visit had been conducted by LPA E. Cortez regarding the incident involving R1. Evidence reviewed during that visit, including the facility’s incident report and the report of suspected dependent adult/elder abuse form (SOC341) submitted by the ED on 03/21/2025 to Community Care Licensing (CCL), confirmed that the incident had occurred. According to the SOC341, ED acknowledged that S1 fed R1 food from a bowl with paw prints containing dog food, rather than from the community’s kitchen bowl containing Spaghetti prepared for residents. The facility’s internal investigation further confirmed that S1 was laughing about the incident and shared details of their actions with other staff members. R1 did not ingest the dog food and reportedly spat it out immediately. Following the incident, the ED contacted R1’s responsible person and their physician and removed S1 from employment as of 03/31/25. Additionally, all staff were retrained on mandated reporting requirements and abuse prevention procedures. Based on the information gathered during the investigation, the department has sufficient evidence to confirm this allegation occurred. As a result, the allegation of “staff do not treat residents with dignity or respect” has been SUBSTANTIATED at this time. However, this issue was previously addressed during a case management visit conducted on 04/09/2025, at which time citations were issued. Therefore, no citations will be issued today.

Regarding allegation of “Staff failed to meet resident incontinent needs while in care”. It was alleged that facility’s staff left Resident #1 (R1) covered in feces from head to toe in R1’s bed. Interviews conducted reflected that on 09/30/2025, at approximately 8:45 A.M., R1’s family member found R1 covered with urine and feces. Additionally, it was also revealed that prior to this incident R1 was often found in briefs saturated with urine in the morning.

Continued on LIC 9099-C

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 29-AS-20251006091242
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: 10/15/2025
NARRATIVE
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Continued on LIC 9099-C

Staff interviews conducted revealed that R1 can be resistant to care at times, becomes easily agitated, and would often refuse showers or care-related assistance. Additionally, even though there is no documentation stating R1 requires frequent monitoring, staff who provide care to R1 stated that due to R1’s condition, R1 requires more frequent monitoring. Additionally, it was revealed that all staff are aware that R1 should be checked at least once every hour. During the interview, staff #2 (S2) reported that on the morning of 09/30/2025, at approximately 6:10 AM, the night shift staff (S3) verbally informed them that R1 had been cleaned and did not require further assistance at that time and proceeded with their regular morning duties, responding to other residents who called for assistance without checking on R1. An interview with the ED revealed that S2 acknowledged that they relied on the information provided by S3 and did not verify R1’s status during the transition between shifts. During today's visit, the LPA reviewed the facility's camera footage from the date of the reported incident. The footage showed that S3 entered R1's room at approximately 5:16 AM and exited at 5:17 AM. The next individual observed entering R1's room was the family member, who arrived at approximately 8:52 AM. Based on the information gathered and record reviewed during the investigation, the department has sufficient evidence to confirm this allegation occurred. As a result, the allegation of “Staff failed to meet resident incontinent needs while in care” has been SUBSTANTIATED at this time.

Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 809-D.) Administrator was informed that failure to correct the deficiencies may result in civil penalties.

Exit interview conducted, appeal rights discussed, and a copy of this report and appeal rights were provided.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 29-AS-20251006091242
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/15/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/30/2025
Section Cited
CCR
87625(b)(3)
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87625 Managed Incontinence (b)…Requirements for Allowable Health Conditions, the licensee shall be responsible...:(3) Ensuring that incontinent residents are kept clean and dry and that the facility... This requirement is not met as evidenced by:
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ED conducted a in-service training with caregivers regarding R1's needs, refusals and incontinent frequently checks.
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Based on interviews and records review, the licensee did not comply with the section cited above, as facility staff failed to ensure that R1 was kept clesn and dry, which posed an immediate health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6