197608267-5-5-2025-31-AS-TAGD-DGWMUD-20250522095456

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 05/05/2025
Date Signed: 05/05/2025 02:50:44 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
04/29/2025 and conducted by Evaluator Gina Saucedo

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20250429094041

FACILITY NAME:	CEDARS ASSISTED LIVING, THE		FACILITY NUMBER:	197608267
ADMINISTRATOR:	STEPHAN SARMAZIAN		FACILITY TYPE:	740
ADDRESS:	17300 ROSCOE BLVD.		TELEPHONE:	(818) 344-2042
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91325
CAPACITY:	175	CENSUS: 105	DATE:	05/05/2025
		UNANNOUNCED	TIME BEGAN:	12:14 PM
MET WITH:	Mary Jane Reyes, Resident Care Director		TIME COMPLETED:	03:05 PM

ALLEGATION(S):

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Staff did not provide resident with copy of admission agreement
Staff did not provide resident with itemized monthly statement
Staff are not providing adequate food service to resident
Staff are not providing laundry service to resident

INVESTIGATION FINDINGS:

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On 05/05/25, at 09:40am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, subsequent complaint visit and was greeted by Resident Care Director, Mary Jane Reyes. LPA explained the purpose of this visit was to gather additional information, interview staff and residents and deliver findings for this complaint.

On 05/01/25, LPA Melissa Spaeth conducted the initial visit. On 05/05/25, LPA Saucedo asked for the census, staff, and resident rosters. On 05/05/25, 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: 05/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2025

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 3

Control Number 31-AS-20250429094041

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: 05/05/2025

NARRATIVE

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Regarding the allegation: Staff did not provide resident with copy of admission agreement. It is being alleged that resident #1 (R1) did not receive a copy of their admission agreement. During LPA's record review, R1 signed their own paperwork on February 04, 2025. LPA received a copy of R1's admission agreement along with the itemized statement. LPA interviewed two (2) staff that confirmed R1 along with all residents get a copy of everything they sign when they arrive at the facility. Furthermore, the business manager confirmed they have given R1 copies of their admission agreement because they asked for it recently when R1 was told they never paid February's rent. During LPA's interview with R1, R1 did not remember if they got a copy of their admission agreement. LPA asked the business office to make another copy of R1's admission agreement and it was provided to R1 in front of LPA. Therefore, based on the LPA's record review, resident and staff interviews, the above allegation(s) above is UNSUBSTANTIATED at this time.

Regarding the allegation: Staff did not provide resident with itemized monthly statement. It is being alleged that resident #1 (R1) did not receive an itemized monthly statement of services. The itemized monthly statement of services is provided under the admission agreement that was given to R1. Furthermore, R1 is under level 1. R1 is ambulatory and does not require any type of additional services. R1's monthly payment for rent is $700.00 for their portion to pay and the company Noble Quest pays their other portion but Noble Quest has not been approved yet. Let it be noted, R1 never paid for February's rent and now has an agreement with the business office to pay $104.00 per month for the next five (5) months. R1 paid $105.00 on April 15, 2025 for past rent for February. LPA received a copy of the Promissory Note that R1 signed on 04/30/25 and a copy of the receipt that was given to R1 regarding the $105.00 payment towards February's rent. Furthermore, the business office manager stated R1 paid the $105.00 in cash. Therefore, based on the LPA's record review, resident and staff interviews, the above allegation(s) above is UNSUBSTANTIATED at this time.

Regarding the allegation: Staff are not providing adequate food service to resident. It is being alleged that resident #1 (R1) does not get meals and has to buy their own food. During LPA's interview with R1, R1 stated, they did not like the food at the facility and would continue to buy their own food. R1 also stated I have a microwave in my room. LPA stated to R1 that three (3) meals are served everyday and there is alternative menus if they do not like the food. Therefore, based on the LPA's record review, resident and staff interviews, the above allegation(s) above is UNSUBSTANTIATED at this time.

LIC 9099C-continued

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2025

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20250429094041

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: 05/05/2025

NARRATIVE

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Regarding the allegation: Staff are not providing laundry service to resident. It is being alleged that resident #1 (R1) is not receiving laundry services. During LPA's physical tour, the washers and dryers were working properly and were in use. During LPA's physical tour, R1 was returning from doing their own laundry and LPA helped R1 carry their laundry. During LPA's interview with R1, R1 stated, they would not be doing their laundry in the dirty washing machines and would instead like to do it themselves outside of the facility. LPA received the laundry schedule that states R1's laundry is done every Wednesday between 6:30am and 2:30 and informed R1 of this. Therefore, based on the LPA's record review, resident and staff interviews, the above allegation(s) above is UNSUBSTANTIATED at this time.

Exit interview conducted, and copy of the report was signed and given to the Resident Care Director.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2025

LIC9099 (FAS) - (06/04)

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