<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608267
Report Date: 03/13/2024
Date Signed: 03/13/2024 02:00:10 PM


Document Has Been Signed on 03/13/2024 02:00 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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, THEFACILITY NUMBER:
197608267
ADMINISTRATOR:KANDICE VERGARAFACILITY TYPE:
740
ADDRESS:17300 ROSCOE BLVD.TELEPHONE:
(818) 344-2042
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY:175CENSUS: 120DATE:
03/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Mary Jane ReyesTIME COMPLETED:
02:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 03/13/24 at 9:05AM, Licensing Program Analyst (LPA) Gina Saucedo, arrived to conduct an unannounced, annual inspection at the facility. Upon arrival, LPA Saucedo met with Resident Care Director Mary Jane Reyes and disclosed the purpose of the visit.

LPA asked for the census, resident, and staff rosters.


A physical tour was conducted at 11:10 AM and observed the following:



The entire facility has a total of 175 (one-hundred and seventy-five) beds. The facility is a two-story building: First floor and second floor: It is both assisted living and memory care. The facility has two (2) memory care units: Evergreen located on the second floor and Willow located on the first floor. There are two medication rooms one on the first floor and one on the second floor. The Evergreen Memory Care section of the facility has their own activity, television, and dining hall area. The door has a code and delayed egress on the doors. The other Memory Care-Willow also has its own activity, television, and dining hall area. The assisted living side has their own activity room on the second floor, dining hall on the second floor and a television room on the first floor. The assisted living side has access to a huge patio area with proper seating for residents.

Random Bedrooms were randomly selected to tour and were observed to have appropriate furniture, lightening, bedding, and televisions. Random Bathrooms were observed to have grab bars and non-skid mats. Hot water temperature was tested randomly for and measured 105–118-degree Fahrenheit.

LIC 809C-continued
SUPERVISOR'S NAME: Troy AgardTELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Gina SaucedoTELEPHONE: (818) 304-3057
LICENSING EVALUATOR SIGNATURE:
DATE: 03/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/13/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 03/13/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Fire extinguishers were observed throughout the facility and were fully charged on green with different dates. There are fire extinguishers upstairs, downstairs and in the kitchen area. Carbon Monoxide and fire alarms are located throughout the facility and are operable.

Facility has two designated medication rooms that are inaccessible to residents where all the medication is stored and locked in the memory care side of the facility. There are always two (2) med-tech staff in the facility during the daytime for each side-memory care and assisted living.

Common Areas: These include the dining areas, activities room, television rooms: All common areas were observed to be cleaned and properly furnished. Facility maintains a comfortable temperature of 69.-78-degree Fahrenheit. There are several temperature thermostats throughout the facility.

There are several common bathrooms throughout the upstairs and downstairs area. The staff and resident bathrooms are not shared. There are trash cans with lids and covid signs posted in the common bathrooms. There is toilet paper and napkins. The facility has no body of water.

There is one facility laundry area on the first level with chemicals inaccessible to the residents. The staff lounge is also located on the first level of the facility.

The Kitchen area was toured, and LPA observed sufficient supply of non-perishable foods and perishable food for all residents. The kitchen area was clean at the time of the tour. The kitchen is located on the first floor. The assisted dining area has access to this kitchen where at the time of the tour different residents were having lunch with proper feeding utensils/plates/cups.

Administrative: There is no annual fee that is due right now. The Insurance plan is dated as of 07/2024. There is an Emergency Disaster plan, Personal Right, Rights of Resident Council, YES, Licensee, and Ombudsman sign on your left-hand side at the entrance of the facility, Fire Drill-February 19, 2024.

An exit interview was conducted, no citations were issued, and a copy of this report was given to the administrator.

SUPERVISOR'S NAME: Troy AgardTELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Gina SaucedoTELEPHONE: (818) 304-3057
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2