197608267-8-14-2023-31-AS-EMIR-D7VUEZ-20240806153157

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 08/14/2023
Date Signed: 08/14/2023 12:50:35 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 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
06/13/2023 and conducted by Evaluator Evelin Rios

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20230613163023

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: 142	DATE:	08/14/2023
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Mary Jane Reyes		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff do not provide adequate bathing assistance to resident in care.
Facility did not arrange, or assist in arranging, for necessary medical care for resident(s).

INVESTIGATION FINDINGS:

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On 08/14/2023 Licensing Program Analysts (LPAs) Evelin Rios and Christopher Alemoh conducted a subsequent unannounced complaint visit for the above allegations. LPA arrived at the facility at 9:30 a.m. and were greeted by Mary Jane Reyes the Resident Care Director. LPA explained to the Resident Care Director reason for the visit. At 9:40 a.m. an entrance interview was conducted with Mary Jane Reyes.

At approximately 10:00 a.m. LPAs and Mary Jane Reyes conducted a physical plant tour of the facility. No health and safety issues were observed.
Allegation #1: Staff do not provide adequate bathing assistance to resident in care.
It is alleged staff is not assisting resident #1 (R1) with their hygiene. To investigate this allegation LPA Rios reviewed resident records on 06/21/2023. R1's physician's report revealed R1 is not able to bathe self or dress/groom self. Review of R1's service plan revealed facility will help resident to maintain independence with activities of daily living but supervise R1 with showers for safety due to unsteady gait. (Continued LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Evelin Rios	TELEPHONE: 424-299-6104
LICENSING EVALUATOR SIGNATURE:	DATE: 08/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2023

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-20230613163023

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: CEDARS ASSISTED LIVING, THE	FACILITY NUMBER: 197608267
	VISIT DATE: 08/14/2023

NARRATIVE

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LPA Rios conducted interviews of residents and staff on 06/21/2023. Interview with R1 revealed they prefer to take showers when a particular staff is working. R1 revealed they don't need to be reminded or told when to shower. Staff interviews revealed they encourage R1 to shower and R1 will usually take direction but occasionally R1 will say they already showered or they refuse to shower. Based on interviews and record review, although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Allegation #2: Facility did not arrange, or assist in arranging, for necessary medical care for resident(s).
It is alleged facility is not assisting R1 with access to medical care. To investigate this allegation LPA Rios reviewed resident and facility records on 06/21/2023. Unusual Incident/Injury Report for 06/07/2023 revealed R1 was sent to the hospital for an altered state of mind. Discharge document for hospital visit on 06/07/2023 revealed R1 had an upper arm fracture. Interview with R1 revealed they had a fall and could not recall to LPA the date it happened or if they told staff. Interview with Mary Jane Reyes on 08/14/2023 revealed the facility was unaware of the fracture until R1 was released from the hospital. Interview with various staff revealed R1 had not complained about pain prior to the 06/07/2023 incident. Based on interviews and record review, although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Exit interview conducted. Appeal rights discussed. Copy of report provided.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Evelin Rios	TELEPHONE: 424-299-6104
LICENSING EVALUATOR SIGNATURE:	DATE: 08/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2023

LIC9099 (FAS) - (06/04)

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