197608267-8-6-2024-31-AS-NMAN-D8ERVQ-20240823132157

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 08/06/2024
Date Signed: 08/06/2024 05:05:00 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
07/28/2023 and conducted by Evaluator Antonia Alvizar-Ettima

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20230728073109

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: 130	DATE:	08/06/2024
		UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Resident Care Director, Mary Jane Reyes		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff do not safeguard residents personal belongings
Resident suffered a fall with injury due to staff negligence
Staff did not seek timely medical attention for resident
Staff do not provide feeding assistance to the resident
Resident was abused and humiliated at the facility
Staff did not provide proper medication assistance to the resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Antonia Alvizar - Ettima conducted unannounced complaint visit to the facility to complete investigation of the above noted allegations. LPA met with Resident Care Director, Mary Jane Reyes and explained the reason for the visit. Later Administrator Kandice Vergara joined us.

During initial investigation conducted on 08/03/2023, at 10:45AM LPA request copies of the facility resident and staff roster. At 11:20AM LPA requested copies of resident #1 (R1) and resident #2 (R2s) records included but not limited to Identification and Emergency Information, Physician’s Report, Resident Appraisal, Needs and Services, Unusual Incident Reports, Inventory records for Personal Property and Valuables, Internal Notes and Medication Administration Records. Between 11:50AM – 2:50PM, LPAs interviewed the Resident Care Director (RCD), 2 staff assisting R1 and R2 and one (1) resident R2. At the time of investigation R1 was no longer in the facility.

Prior to this visit on 08/06/24 at 8:45AM LPA reviewed all facility records received during initial visit.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima	TELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:	DATE: 08/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2024

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 3

Control Number 31-AS-20230728073109

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: 08/06/2024

NARRATIVE

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Staff do not safeguard residents personal belongings.
It was alleged that the facility staff did not safeguard R1’s and R2’s personal belongings.
Interviews revealed that in the memory care residents’ belongings are being safeguarded and valuables are stored in the locked cabinet by RCD, Staff revealed that R1’s and R2’s belongings and valuables were never inventoried by resident and/or responsible party. R1 had a watch, and it was stored in the locked cabinet and was given to R1’s responsible party when R1 was moving out of the facility. R2 reported missing bag with personal items and money. During the time of the incident R2 was going out in the community daily with a friend and returning to facility intoxicated. Staff conducted an internal investigation and did not find the missing bag. R2 informed a staff on 11/20/2023 that friend found R's bag and returned it. Staff was informed about the missing money and they offered to file a police report on R2’s behalf and R2 refused at that time. During this investigation at 3:15PM R2’s interview confirm that missing items were returned, and staff do safeguard resident’s personal belongings. Upon review of R1’s and R2’s records, LPA noted that both residents’ belongings were not recorded.

Based on interviews and record review it was concluded that although the allegation may have happened, however, there is insufficient information to confirm the validity of the complaint. Therefore, the allegation is unsubstantiated at this time.

Resident suffered a fall with injury due to staff negligence.
Staff did not seek timely medical attention for resident.

It was alleged that while staff was assisting R1, they "slipped" out of the staff's arms and fell hurting his elbow. R1’s elbow was dislocated, and staff did not take the resident to have his elbow looked at. Staff revealed that R1 never had dislocated elbow and did slipped out while assisted by staff. R1 never complain of the pain. Sometime in July 2023, R1 had unwitnessed fall. When R1 sits on the wheelchair, they suit themselves to the end of wheelchair and may easily loos the balance. R1 injured 2 fingers. Staff called emergency transportation and R1 was send to the hospital. At the time of investigation, R1 was no longer at the facility. LPA Alvizar - Ettima reviewed incident report, regarding R1’s unwitnessed fall. The report verified the information received from facility staff.
Based on interviews and record review, there is insufficient information to verify the allegation. Therefore, the allegation is unsubstantiated at this time.

Continue on LIC 812c

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima	TELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:	DATE: 08/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2024

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20230728073109

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: 08/06/2024

NARRATIVE

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Staff do not provide feeding assistance to the resident.
Concerns were addressed that R1 can't see, and the staff are supposed to assist the resident with feeding. The staff just blend up the resident's food and set it in front of them to eat. Interviews revealed that R1 had vision problem however did not require feeding assistance. R1 was hard of hearing. R1 did not like to eat breakfast, but they always ate lunch and dinner. Some time R1 would ask for oatmeal for breakfast and staff always brings the oatmeal for R1. A review of R1s records verified the information revealed from the staff.

No information was revealed during this investigation to support the allegation. Therefore, the allegation is Unsubstantiated at this time.

Resident was abused and humiliated at the facility.
It was alleged that someone (unknown if it is staff or other residents) are coming into the R1’s room at night and "slapping" the resident upside the head and other times will hold the resident's nose and put their hand over the residents’ mouth. Staff denied entering residents’ rooms and humiliating R1 or other residents.
Staff stated that residents supervised at night and no one is wondering or going to the other residents rooms. During this visit between 11:55a.m. – 1:00p.m. LPA interviewed eleven (11) residents and the residents denied being humiliated by the facility staff. A review of facility documents and internal incident log did not reveal any information to support the allegation, except that R1 had aggressive and disrespectful behavior towards facility staff and other residents.

Based on interviews and record review there is insufficient information to verify the allegation. Therefore, the allegation is Unsubstantiated at this time.

Staff did not provide proper medication assistance to the resident.
It was alleged that the staff are not giving the resident (R1’s) medications.
Staff interviews revealed that R1 always received their medications as prescribed. Since R1 was no longer in the facility LPA was unable to review R1’s medication supply. A review of R1’s medication Administration Records revealed that R1’s medication was dispensed as per doctor’s order. During this investigation, between 11:55a.m. – 1:00p.m. LPA Alvizar-Ettima spoke with eleven (11) residents and they did not have any concerns regarding their medication assistance.

Based on interviews and record review there is no sufficient information to verify the allegation. Therefore, the allegation is unsubstantiated at this time.

Exit interview conducted. Copy of this report was provided to Administrator.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima	TELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:	DATE: 08/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2024

LIC9099 (FAS) - (06/04)

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