197608267-9-5-2024-31-AS-EMIR-D8ZMS4-20240911095115

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 09/05/2024
Date Signed: 09/05/2024 01:40:16 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
05/27/2021 and conducted by Evaluator Michael Cava

COMPLAINT CONTROL NUMBER: 31-AS-20210527105206

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: 110	DATE:	09/05/2024
		UNANNOUNCED	TIME BEGAN:	09:38 AM
MET WITH:	Mary Jane Reyes		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Resident choked on food due to lack of supervision.
Resident developed a UTI while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Michael Cava conducted a subsequent complaint visit to the facility to amend and conclude the investigation regarding the above allegations. LPA met with the Resident Care Director, Mary Jane Reyes and advised her of the allegations

Resident chocked on food due to lack of supervision:
In regards to the allegation, It was reported that on or around 5/21/2021 Resident 1 (R1) choked on their food because they were left eating unsupervised. R1 requires supervision during meals. Interviews were made with the administrator, Resident Care Director (RCD) and staff reveal that R1 was verbal, able to communicate their needs, required a mechanical diet, but was able to feed self, requiring no supervision. Information received by Investigations Branch (IB) received during their investigation indicated that R1 was total assist. This information received was outdated. During the course of LPA Cava’s investigation, updated information, pertaining to R1’s medical assessment and needs and services were received.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024

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-20210527105206

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: CEDARS ASSISTED LIVING, THE	FACILITY NUMBER: 197608267
	VISIT DATE: 09/05/2024

NARRATIVE

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This information reveal that, at admission to the facility, although R1 required a mechanical diet, R1 was able to feed self. In addition, R1’s post discharge papers from the rehabilitation center where R1 came from was also obtained. It indicates R1 can feed self and no longer requires services from the rehabilitation center, resulting in R1 being discharged to an assisted living. Moreover, this allegation held trial. R1’s family had to settle based on their attorney’s advice that “it was in the court’s opinion that the facility staff did all they possibly could have to prevent R1 from choking.

Based on the information obtained, there wasn’t enough evidence to prove that R1 choked on food due to lack of supervision. Therefore, the allegation is deemed Unsubstantiated at this time.

Resident developed a UTI while in care:
In regards to the allegation, the initial investigation was made by LPA Alex Pitz on 02/10/22. Based on LPA Pitz’s interviews and record review, the allegation was Substantiated at that time. A further review of this allegation was made. Based on that review, there was no substantiative evidence available with regards to the allegation involving R1 developing UTI to prove the facility is at fault. Therefore, the allegation is changed to Unsubstantiated. RCD advised and a copy of this report issued.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024

LIC9099 (FAS) - (06/04)

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