197608267-8-23-2023-31-AS-EMIR-D8BTNP-20240820145303

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 08/23/2023
Date Signed: 08/23/2023 02:43:21 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
08/16/2023 and conducted by Evaluator Evelin Rios

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20230816112650

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: 144	DATE:	08/23/2023
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Mary Jane Reyes		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff inappropriately placed resident in memory care.
Staff yelled at residents.

INVESTIGATION FINDINGS:

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On 08/23/2023 Licensing Program Analyst (LPA) Evelin Rios conducted an unannounced complaint visit for the above allegations. LPA arrived at 9:30 a.m. and was greeted by Resident Care Director, Mary Jane Reyes. LPA explained the reason for the visit. An entrance interview was conducted with Mary Jane Reyes. Shortly after LPA met with the administrator Kandice Vergara and explained the reason for the visit.

At approximately 10:00 a.m. LPA and Mary Jane conducted a physical plant tour of the facility. Along with the tour LPA interviewed seven (7) residents and six (6) staff including Kandice and Mary Jane. From approximately 11:30 a.m. - 1:00 p.m. LPA reviewed and obtained documents relevant to the investigation.

Allegation #1: Staff inappropriately placed resident in memory care.
It is alleged resident #1 (R1) was misplaced in memory care with other residents who have severe dementia and Alzheimer’s. To investigate this allegation LPA Rios reviewed resident records and conducted interviews with Administrator and Resident Care Director. (Continued on 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: 08/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023

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-20230816112650

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: 08/23/2023

NARRATIVE

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(LIC9099-C Continued)
According to the Administrator a residents' physician's diagnoses along with a facility assessment determines placement of resident into memory care or the assisted living units of the facility. At this facility there are two units designated as memory care and one for assisted living residents. According to Kandice both memory care units are appropriate for dementia residents and neither one is predominately for sever dementia residents. Residents can be placed in either memory care unit depending on availability or ambulatory status. LPA's review of R1's, Resident Appraisal, Admission Agreement, Assisted Living Waiver along with hospital paperwork revealed, R1 is mostly independent with activities of daily living however records also indicate R1 requires assistance with prompts and reminders due to forgetfulness and confusion. R1's Physician's Report revealed a diagnoses of dementia. 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 #1: Staff yelled at residents.
It is alleged staff #1 (S1) yells at residents. To investigate this allegation LPA Rios conducted interviews with S1 and various staff including Administrator and Resident Care Director. LPA also interviewed seven (7) residents from different units of the facility. LPA interviews with staff deny the allegation. Various staff revealed they have only heard resident's yell at each other or to staff. According to Kandice there was a recent incident between residents involving R1 and due to room changes, R1 may be upset at S1 since S1 was involved with moving items out of R1's shared bedroom. During physical plant tour of one of two memory care units LPA observed most residents in the activity room with the Activities Director engaged in sitting exercises with music playing. LPA observed in the hallway, S1 and R1 engaged in a conversation. Both were speaking louder than the music playing. R1 was accusing S1 of removing bed sheets and a pillow case from his room. Both S1 and R1 were going back a forth for less than a minute with S1 first denying the allegation then agreeing with R1. R1 kept revisiting the discussion while LPA was in the memory care unit. Interview with S1 revealed they speak a certain way and may be interpreted as yelling but deny the allegation. S1 states all they can do is try to keep their distance when R1 is agitated. Interviews with residents did not corroborate the allegation. Based on interviews, 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.

No deficiencies cited. Exit interview conducted. 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: 08/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023

LIC9099 (FAS) - (06/04)

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