197608267-7-30-2024-31-AS-TAGD-D8YLLD-20240910085055

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 07/30/2024
Date Signed: 07/30/2024 03:14:33 PM

Substantiated

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
07/24/2024 and conducted by Evaluator Gina Saucedo

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20240724141451

FACILITY NAME:	CEDARS ASSISTED LIVING, THE		FACILITY NUMBER:	197608267
ADMINISTRATOR:	KANDICE VERGARA		FACILITY TYPE:	740
ADDRESS:	17300 ROSCOE BLVD.		TELEPHONE:	(818) 344-2042
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91325
CAPACITY:	175	CENSUS: 121	DATE:	07/30/2024
		UNANNOUNCED	TIME BEGAN:	09:55 AM
MET WITH:	Mary Jane Reyes		TIME COMPLETED:	03:25 PM

ALLEGATION(S):

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Staff hit resident
Staff speaks inappropriately to residents

INVESTIGATION FINDINGS:

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On 07/30/24, at 9:55am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, initial complaint visit and was greeted by Resident Care Director Mary Jane Reyes. LPA disclosed the purpose of the visit. LPA explained the purpose of this visit was to gather information, conduct staff and resident interviews and deliver findings for this complaint.

The investigation consisted of the following: LPA Saucedo asked for the census, requested the staff and resident roster. At 11:15am, LPA toured the physical plant. During the tour, residents and staff were interviewed.

9099C-continued

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Gina Saucedo	TELEPHONE: (818) 304-3057
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024

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-20240724141451

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: 07/30/2024

NARRATIVE

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Regarding the allegation: Staff hit resident. It is being alleged that Staff #1 (S1) is aggressive to residents. Resident #1 (R1) was able to confirm that S1 hit them in the back of the neck, top of the head, and kicked them. Resident #2 (R2) confirmed that S1 choked them and Resident #3 (R3) was a witness to R2. Resident #4 (R4) confirmed that S1 grabbed and pulled them by the hand pushing them against a chair. Resident #5 (R5) suspects that they were hit behind the head by S1 because S1 was around them at the time but cannot confirm it because when they turned around from their wheelchair S1 was no longer around. LPA was able to confirm a cut behind the head of R5 and the Unusual/Incident/Injury Report. Seven (7) out twelve (12) residents have heard S1 being aggressive with other residents. Two (2) out of two (2) staff confirmed that they have received complaints about S1. Therefore, based on the LPA's observations, staff, and resident interviews the above allegation(s) is SUBSTANTIATED at this time.

Regarding the allegation: Staff speaks inappropriately to residents. It is being alleged that Staff #1 (S1) yells at residents. Twelve (12) out of twelve (12) residents confirmed that they have been yelled at and disrespected by S1. Two (2) out of two (2) staff confirmed that they have received complaints about S1. Furthermore, one (1) staff did confirm that S1 is impatient and yells at residents. Therefore, based on the LPA's observations, staff, and resident interviews the above allegation(s) is SUBSTANTIATED at this time.

An exit interview was conducted, citation(s) were issued for the above allegation(s), and a copy of this report was given to the Resident Care Director with the appeals rights.

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Gina Saucedo	TELEPHONE: (818) 304-3057
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20240724141451

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/30/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/31/2024 Section Cited CCR 87468.1(a)(3)	1 2 3 4 5 6 7	87468.1(a)(3) Personal Rights of Residents in All Facilities.(a)Residents in all residential care facilities for the elderly shall have all of the following personal rights:(3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature..This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The licensee/admnistrator shall immediately place the staff on administrative leave or/and remove the staff from all care given to the residents.
	8 9 10 11 12 13 14	Based on the LPA's Interviews the licensee/administrator did not ensure that staff provide an environment free of punishment/intimidation/abuse of residents in care which poses an Immediate Health, Safety or Personal Rights risks to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Gina Saucedo	TELEPHONE: (818) 304-3057
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024

LIC9099 (FAS) - (06/04)

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