197608267-9-14-2021-31-AS-JAPL-C6Y5NK-20210917200624

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 09/14/2021
Date Signed: 09/14/2021 03:03:27 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
03/30/2020 and conducted by Evaluator Kasandra Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20200330085412

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: 108	DATE:	09/14/2021
		UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	Aris Vergara		TIME COMPLETED:	01:40 PM

ALLEGATION(S):

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Staff unlawfully evicted the resident
Facility roof leaks

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) KaSandra Lopez conducted an unannounced subsequent complaint inspection at the facility today and met with Administrator Aris Vergara at 12:20 PM. The LPA explained the reason for today's inspection.

During today's inspection, the LPA conducted interviews with Administrator Aris Vergara and Candace Vergara beginning at 12:20 PM. At 12:25 PM the LPA conducted a physical plant tour with Mr. Vergara. Between 12:29 PM and 12:39 PM the following apartments were observed, #103, # 225, # 253, #260, #273, and #275.

During the initial complaint inspection on 04/02/2020, due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, LPA Perera conducted a telephonic interview with Mr. Vergara beginning at 1:50 PM and obtained pertinent records pertaining to Resident #1 (R1) and maintenance photographs. Report continued on LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra Lopez	TELEPHONE: (818) 421-5138
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021

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-20200330085412

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: 09/14/2021

NARRATIVE

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The allegation of 'Staff unlawfully evicted the resident' alleges R1 was removed from the facility after running some errands and the complainant did not know where R1 went. Interviews with the Administrator Aris Vergara and Candace Vergara revealed R1 was part of a county program, Brilliant Corners that places homeless residents in facilities until permanent placement can be found. They stated R1 was not evicted but in need of a lower level of care and moved to an independent setting on 03/27/2020. Facility records revealed R1 was admitted on 02/08/2020 and moved out on 03/27/2020 and was part of the county program. On 09/13/21, LPA Lopez attempted to contact a social worker assigned to R1 but did not receive a returned call.
Based on the information obtained, the allegation of 'Staff unlawfully evicted the resident' is deemed unsubstantiated at this time.

The allegation of 'Facility roof leaks' alleged the roof was leaking in 10 resident rooms. During the initial telephonic inspection on 04/02/2020, Mr. Vergara stated there had been leaks due to recent heavy rain and stated the dry wall in the rooms was fixed on the previous day. Mr. Vergara stated they needed to wait for the rain to stop before they could start the repairs. Mr. Vegara said everything was fixed in about four days in rooms 103, 225, 253, 260, 273, and 275. Mr. Vergara sent LPA Perera photos of rooms with repaired dry wall. During today's inspection the LPA observed the resident rooms noted. All rooms were repaired and painted. Based on the information, obtained the allegation of 'Facility roof leaks' is found unsubstantiated as there is evidence that supports the repairs to the rooms were made timely.

Exit interview conducted and report reviewed with Mr. Vergara. A copy of the report and appeal rights will be emailed.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra Lopez	TELEPHONE: (818) 421-5138
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021

LIC9099 (FAS) - (06/04)

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