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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 04/29/2025
Date Signed: 04/29/2025 02:19:10 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
01/02/2025 and conducted by Evaluator Gina Saucedo
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20250102105433
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: 105DATE:
04/29/2025
UNANNOUNCEDTIME BEGAN:
11:07 AM
MET WITH:Jolene Halog, Medication TechnicianTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff did not provide medication assistance to resident in care resulting in hospitalization
Staff did not provide foods of good quality to residents in care
Staff left residents unattended
INVESTIGATION FINDINGS:
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On 04/29/25, at 11:07am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, subsequent complaint visit and was greeted by Jolene Halog, Medication Technician. LPA explained the purpose of this visit was to gather additional information, interview staff and residents and deliver findings for this complaint.

On 01/03/25, LPA Ngo-Castaneda conducted an initial complaint, asked for the census, staff, and resident rosters and conducted a physical tour. On 04/29/25, LPA Saucedo asked for the census, staff, and resident rosters. On 04/29/25, 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: 04/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2025
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-20250102105433
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: 04/29/2025
NARRATIVE
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Regarding the allegation: Staff did not provide medication assistance to resident in care resulting in hospitalization. It is being alleged that resident #1 (R1) did not receive their blood pressure or diabetes medication on 01/01/25. During LPA’s record review, LPA obtained the medication administration record of R1 where it showed R1 took several medications the morning of 01/01/25 including their blood pressure and diabetes medication. LPA also interviewed staff #1 (S1) that provided the medication to R1, and the staff confirmed R1 took their medication. LPA interviewed ten (10) other residents and asked if their medication is provided to them every day and at their designated time and ten (10) residents confirmed that they do not have any problems with their medication being distributed to them. Based on the LPA's observations, record reviews, staff and resident interviews conducted the allegation is UNSUBSTANTIATED at this time.

Regarding the allegation: Staff did not provide foods of good quality to residents in care. It is being alleged that the food at the above facility is horrible. LPA obtained the meal menus that are provided to the residents. In addition, there is an alternative menu provided to the residents to chose from other meals if they do not like what is being served and there is two (2) snack vending machines. LPA interviewed ten (10) residents that confirmed the food is either decent, and/or they do not eat meals at the facility because they have their own food in their room or some residents chose from the alternative menu. Based on the LPA's observations and record reviews, staff and resident interviews conducted the allegation is UNSUBSTANTIATED at this time.

Regarding the allegation: Staff left residents unattended. It is being alleged that a resident was left unattended after complaining of not feeling well. LPA interviewed four (4) staff. (S1) stated they provided R1 with their medication and vitals that morning and observed R1 was fine and alert towards the end of their shift. (S2) stated they were called by a resident around 3:10pm regarding R1 had collapsed on the floor upstairs. S2 called (S3) and (S4) to let them know that R1 collapsed and was on the 2nd floor. S4 went to the 2nd floor, called 911 and performed CPR until 911 arrived. When 911 arrived, they continued giving R1 CPR until they were pronounced deceased at 4:02pm. LPA interviewed two (2) residents that confirmed they saw several staff helping R1. One (1) resident confirmed they saw two (2) staff giving R1 CPR-Cardiopulmonary resuscitation. LPA also confirmed with the Los Angeles Morgue to confirm that R1 died of natural causes. Based on the LPA's observations and record reviews, staff and resident interviews conducted the allegation is UNSUBSTANTIATED at this time.

An exit interview was conducted, no citation(s) were issued, and a copy of this report was given to one of the Jolene Halog, Medication Technician.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2025
LIC9099 (FAS) - (06/04)
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