197608267-7-15-2024-31-AS-NGID-D7NUAE-20240730152437

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 07/15/2024
Date Signed: 07/15/2024 01:43:18 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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
11/06/2023 and conducted by Evaluator Leslie Ngo-Castaneda

COMPLAINT CONTROL NUMBER: 31-AS-20231106105909

FACILITY NAME:	CEDARS ASSISTED LIVING, THE		FACILITY NUMBER:	197608267
ADMINISTRATOR:	KANDICE VERGARA		FACILITY TYPE:	740
ADDRESS:	17300 ROSCOE BLVD.		TELEPHONE:	(818) 344-2042
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91325
CAPACITY:	175	CENSUS: 124	DATE:	07/15/2024
		UNANNOUNCED	TIME BEGAN:	09:52 AM
MET WITH:	Kandice Williams- Executive Director		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Licensee did not provide responsible party prompt access to review all resident's records.
Licensee did not respond to communications from resident representative.

INVESTIGATION FINDINGS:

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On 7.15.2024 Licensing Program Analyst (LPA) Leslie Ngo-Castaneda arrived at the facility to conduct an unannounced subsequent visit to deliver the determination on the above allegations. LPA was greeted by Mary Jane Reyes (S2) who is the Resident Care Coordinator of the facility.

Initial visit was done by LPA Agban on 11.15.2023. With the assistance of the administrator, LPA took a tour of the physical plant at 10:10AM. At 10:30AM LPA requested the following documents: staff roster; resident roster, residents’ physician’s report, admissions agreement, appraisals, and other documents. LPA received copies of all the documents requested. LPA interviewed thirteen (13) residents out of one hundred twenty-four (124) residents and two (2) staff from 10:42AM until 12:15PM. LPA reviewed resident’s records at 12:20PM until 1:30PM.

Allegation: Licensee did not provide responsible party prompt access to review all resident’s records
Continue to LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda	TELEPHONE: (818) 214-9900
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2024

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-20231106105909

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: CEDARS ASSISTED LIVING, THE	FACILITY NUMBER: 197608267
	VISIT DATE: 07/15/2024

NARRATIVE

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It was alleged that the facility staff did not provide responsible party prompt access to review all resident’s records.

Resident #1 (R1) had moved out of the facility and staff did not provide and transfer any of the financial records to the family. LPA interviewed residents, thirteen (13) out of one hundred twenty-four (124) residents and 2 staff. LPA interview S1 and S2 and stated that they had emailed the necessary records to the individuals who are only indicated in R1's file only. Based on LPA observation and review of the information received this allegation is unsubstantiated.

Allegation: Licensee did not respond to communications from resident representative.

It was alleged that the facility does not respond to communications from resident representative and block-off their number. R1 family has been trying to communicate and call the facility to obtain all the necessary documents. Interview with S1 and S2 stated they have no way of blocking a certain number since anyone can just call the office and can be helped. S2 also revealed that R1 family has their private number for them to call and communicate regarding R1's condition. Based on LPA's observation and review of the information received this allegation is unsubstantiated.

Exit interview conducted. Report signed and delivered to the executive director.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda	TELEPHONE: (818) 214-9900
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2024

LIC9099 (FAS) - (06/04)

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