197608267-5-16-2024-31-AS-NGID-D72SMN-20240710140013

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 05/16/2024
Date Signed: 05/16/2024 08:08:39 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., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/04/2022 and conducted by Evaluator Angela Panushkina

COMPLAINT CONTROL NUMBER: 31-AS-20220104080541

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: 125	DATE:	05/16/2024
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Kandice Vergara, Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff not safeguarding residents belonging.
Resident does not receive packages in a timely manner.
Facility has mold.
Resident left in soiled diapers for extended amount of time.

INVESTIGATION FINDINGS:

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At 1:00pm, Licensing Program Analyst (LPA) Angela Panushkina conducted a subsequent visit to deliver final findings.LPA met with the Administrator and explained the reason for the visit.

Initial 10-day visit was conducted by LPAs Tan and Smith on 01/13/2022. During that visit, LPAs investigatied complaint control #31-AS-20220104133216 with similiar allegations. In addition, multiple visits were conducted by LPA Martinez ranging from March – October 2022. LPA Martinez conducted physical plant tour and LPA specifically toured R1’s bedroom.

Moreover, on 06/30/2022, LPA Panushkina conducted a subsequent visit. During course of the investigation, interviews and record review were made. At 11:05am, LPA requested resident and staff roster. At 11:10am, LPAs requested copies of pertinent information which include, but not limited to Admission Agreement, Physician’s Report, Appraisal Needs and Services Plan, Preplacement Appraisal, Continue on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024

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 31-AS-20220104080541

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., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: CEDARS ASSISTED LIVING, THE	FACILITY NUMBER: 197608267
	VISIT DATE: 05/16/2024

NARRATIVE

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relevant to the investigation. At approximately 11:15am, LPA conducted a physical plant tour, to ensure health and safety of the residents are protected and physical plant is in compliance with Title 22 Regulations. LPA also conducted an interview with the Administrator, Resident Care Director, Wellness Coordinator, Maintenance Director, 11 out of 11 residents and reviewed facility records.

Allegation: Staff not safeguarding residents belonging.

It is alleged that on 11/27/2021 R1's family member could not find the soaps and tissues that were bought for R1 the week prior. To investigate this allegation, on 06/30/22, LPA conducted an interview with the Administrator, Resident Care Director and Wellness Coordinator. All parties interviewed confirmed that R1 would occasionally receive hygiene supplies, however, it was enough to last one week. An interview conducted with the Resident Care Director also revealed that no staff have lost, stolen or misplaced any of R1’s items. Administrator stated that staff would assist R1 with storing their hygiene supplies, and R1 would often state that their supplies would go missing. However, Administrator does not believe any staff have stolen any of R1’s items. Moreover, LPA conducted an interview 11 out of 11 residents. Ten (10) out of eleven residents, expressed no concerns regarding the above allegation and have not had any hygiene supplies missing/stolen. Based on interviews and LPA observation this allegation is deemed Unsubstantiated at this time.

Allegation: Resident does not receive packages in a timely manner.

It was alleged that the packages sent by R1's family were never provided to R1. To investigate this allegation, LPA conducted an interview with the Administrator, on 06/30/22, who stated that he had not heard complaints from any other resident. Administrator also stated that no staff have been noted to interfere with the resident’s mail. LPA interviewed the concierge who frequently works at the front desk. S1 stated that the mail is sorted into the resident’s individual mail box and is being picked up by residents twice a week. For some residents that are unable to come and pick up their mail/packages, the staff will deliver everything to their room during the day. Interviews with ten (10) out of eleven (11) residents revealed that they have never had any issues receiving their mail. Based on interview’s conducted this allegation is deemed Unsubstantiated.

Continue on LIC9099-C

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20220104080541

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., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: CEDARS ASSISTED LIVING, THE	FACILITY NUMBER: 197608267
	VISIT DATE: 05/16/2024

NARRATIVE

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Allegation: Facility has mold.

It was alleged that R1's family member visited R1 (date unknown) and observed mold around the frame of the window. During the initial visit conducted by LPA Tan it was reported that LPA observed the room in which R1 stayed on 1/5/22 and LPA did not observe any mold in the room nor in R1's oxygen tube. Additionally, LPA Martinez conducted various onsite visits from March - October 2022, and LPA Martinez did not observe any mold on walls nor windows. LPA interviewed the Administrator, and Administrator stated that there were never any reports of mold on the walls or windows made by R1 or staff. Moreover, during 06/30/22 visit, LPA Panushkina conducted an interview with the Maintenance Director who also denied the above allegation. In addition, interviews with ten (10) out of eleven (11) residents revealed that they do not have issues with mold in the room. Lastly, during a physical plant tour, LPA did not observe any mold nor other, mold related issues in resident rooms. Due to interviews conducted, this allegation is deemed Unsubstantiated.

Allegation: Resident left in soiled diapers for extended amount of time

It was alleged that staff left R1 in a soiled diapers for an extended period of time. To investigate this allegation, LPA conducted an interview with R1 on 06/30/22 and was informed that R1 is being changed once or twice during a 24-hour time frame causing R1 to have a rash on bottom. However, interview with the Administrator, Resident Care Director, Wellness Coordinator revealed that the facility staff must change all incontinent residents every two (2) hours or as needed. Interview with three (3) staff members confirmed that during their shift they check/change incontinent residents at least 2-3 times or as needed. Moreover, five (5) incontinent residents interviewed stated that the staff has never left them unclean and that they are assisted to the restroom whenever they request to be taken and or being changed immediately upon request. Lastly, during the subsequent visit conducted on 06/30/22, LPA observed R1 just had a shower and LPA did not observe any strong smells of urine in R1's room. Based on interviews and LPA observation, there is not enough evidence to support the above allegation. Therefore, this allegation is deemed Unsubstantiated at this time.

No deficiencies issued. Exit interview conducted and copy of this report signed and delivered.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024

LIC9099 (FAS) - (06/04)

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