197608267-8-18-2020-31-AS-JAPL-BT5P3K-20200904105740

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 08/18/2020
Date Signed: 08/18/2020 01:45:35 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/09/2020 and conducted by Evaluator Desaree Perera

COMPLAINT CONTROL NUMBER: 31-AS-20200309092927

FACILITY NAME:	CEDARS ASSISTED LIVING, THE		FACILITY NUMBER:	197608267
ADMINISTRATOR:	ARISTOTLE B. VERGARA		FACILITY TYPE:	740
ADDRESS:	17300 ROSCOE BLVD.		TELEPHONE:	(818) 344-2042
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91325
CAPACITY:	175	CENSUS: 101	DATE:	08/18/2020
		UNANNOUNCED	TIME BEGAN:	12:57 PM
MET WITH:	Aristotle Vergara		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff failed to keep the facility free from pests
Facility is in disrepair

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Desaree Perera initiated a subsequent complaint to the above facility. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Aristotle Vergara at 1:20pm. The purpose of the telephonic visit is to conclude an investigation initiated by LPA on 03/19/2020.

It was alleged that the facility staff failed to keep the facility free from pests. During the course of the investigation, LPA conducted interviews with facility staff on 03/19/2020 at 1:50pm; 04/02/2020 at 1:53pm; 07/27/2020 at 10:35am; on 08/13/2020 between 9:55am and 11:00am; and on 08/14/2020 at 11:53am. Interviews with residents were conducted on 07/30/2020 between 12:45pm – 1:00pm; and on 08/13/2020 between 9:48am -11:00am. In addition, LPA conducted a virtual tour of the facility physical plant on 07/30/2020 at 12:30pm.

Continued on LIC9099-C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Desaree Perera	TELEPHONE: (747) 230-3888
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2020

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 2

Control Number 31-AS-20200309092927

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: CEDARS ASSISTED LIVING, THE	FACILITY NUMBER: 197608267
	VISIT DATE: 08/18/2020

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Documents pertinent to the allegation was requested and reviewed on 07/30/2020 and on 08/14/2020. Information gathered revealed that facility has had an ongoing issue with pests. However, the facility has been working with a third-party pest control company that sprays the facility on a monthly basis and also as needed. Interviews conducted revealed that the due to the heat sometimes roaches and ants appear but the facility staff sprays and treats for the pests as soon as they are notified. Moreover, it was also revealed that the pests issues have significantly reduced as of lately. A review of third party pest control company records revealed that there has not been any pest activity in the recent months. However, the facility is constantly getting treatments to avoid potential problems. Based on information gathered, it has been determined that the Department does not have sufficient information to determine the facility staff failed to keep the facility free from pests; therefore, the allegation is deemed UNSUBSTANTIATED at this time.

It was also alleged that the facility is in disrepair and the air conditioning and heater units are dysfunctional. During the course of the investigation, LPA conducted interviews with facility staff on 03/19/2020 at 1:50pm; 04/02/2020 at 1:53pm; 07/27/2020 at 10:35am; on 08/13/2020 between 9:55am and 11:00am; and on 08/14/2020 at 11:53am. Interviews with residents were conducted on 07/30/2020 between 12:45pm – 1:00pm; and on 08/13/2020 between 9:48 am-11:00am. In addition, LPA conducted a virtual tour of the facility physical plant on 07/30/2020 at 12:30pm. Documents pertinent to the allegation was requested and reviewed on 07/30/2020 and on 08/14/2020. Based on information gathered, it has been determined that the Department does not have sufficient information to determine the facility is in disrepair; therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Exit interview conducted/ No citations issued/ A copy of report sent via email for signature.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Desaree Perera	TELEPHONE: (747) 230-3888
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2020

LIC9099 (FAS) - (06/04)

Page: 2 of 2