<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 04/08/2025
Date Signed: 04/08/2025 11:23:15 AM

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
04/04/2025 and conducted by Evaluator Gina Saucedo
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20250404135315
FACILITY NAME:CEDARS ASSISTED LIVING, THEFACILITY NUMBER:
197608267
ADMINISTRATOR:KANDICE VERGARAFACILITY TYPE:
740
ADDRESS:17300 ROSCOE BLVD.TELEPHONE:
(818) 344-2042
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY:175CENSUS: 101DATE:
04/08/2025
UNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH: Jolene Halog, Medication TechnicianTIME COMPLETED:
11:25 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not prevent the resident from being physically assaulted by another resident in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 04/08/25, at 9:05am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, initial complaint visit and was greeted by Medication Technician, Jolene Halog. LPA explained the purpose of this visit was to interview staff, residents and deliver findings for this complaint.

On 04/08/25, LPA Saucedo asked for the census, staff, and resident rosters. On 04/08/25, LPA Saucedo conducted a physical tour and interviewed staff and residents.

LIC 9099C-continued
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2025
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-20250404135315
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: 04/08/2025
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
Regarding the allegation: Staff did not prevent the resident from being physically assaulted by another resident in care. It is being alleged that resident #1 (R1) was assaulted by resident # 2 (R2) and staff did not prevent the assault. During LPA's interview with R1, R1 admitted that R2 and them were friends for a number of years and had met in college and took an English class together before meeting again at the above facility but eventually lost contact. Once they met again at the above facility, they became close friends again and even sat at the same dining table to eat. Let it be noted, both R1 and R2 lived in the assisted living area of the facility. R1 stated that they lost their friendship with R2 over a discussion about a female. R1 continued to say that R2 became very rude to them anytime they would see each other, R1 would just ignore them. R1 remembers the night of the incident, it was around 9:00pm or 10:00pm when R2 tried to come in their room but R1 was able to lock the door. R2 continuously kicked the door and the door eventually opened and R2 came into their room and started to hit them with a cart that R1 had in their room. After R2 hit them with the cart, R2 then picked up a vase and began to hit R1. R1 started yelling and that's when R1 remembers another resident came to help them. LPA asked R1 if they pressed their call button for help but R1 stated, "no, they just started yelling." Resident # 3 (R3) says they saw R2 pacing back and forth down the hallway before the incident happened but didn't mention it to anyone until R3 heard the yelling and R3 said by the time they got to R1's room, R2 started running away. R3 said staff was contacted and staff immediately came and called 911. R1 also confirmed that staff called 911 and they were taken to Northridge Hospital. LPA interviewed staff #1 (S1) and staff confirmed that when they were doing their night rounds they immediately responded and called 911 then R1 was transferred to the local hospital. The incident report was written, and a SOC 341 was also submitted and provided to the Ombudsman and a police report was obtained. LPA obtained the incident report along with the SOC 341. Let it be noted, R2 never returned back to the facility after this incident happened. LPA's interview with R1, R3 S1 and staff #2 (S2) confirmed that R2 never returned to the facility. Therefore, based on the LPA's record review, resident and staff interviews, the above allegation(s) above is UNSUBSTANTIATED at this time.


Exit interview was conducted, no citation(s) were issued for the above allegation(s) and a copy of this report was given to the Medication Technician, Jolene Halog.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2