197608267-9-16-2024-31-AS-TAGD-D9UP7J-20241008110401

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 09/16/2024
Date Signed: 09/16/2024 02:22:28 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
09/13/2024 and conducted by Evaluator Gina Saucedo

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20240913153942

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: 109	DATE:	09/16/2024
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Mary Jane Reyes, Resident Care Director		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Unlawful eviction
Facility staff financially abuse resident

INVESTIGATION FINDINGS:

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On 09/16/24, at 9:45am, 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 11:05am, LPA toured the physical plant. During the tour, residents and staff were interviewed.

9099C-continued

Unsubstantiated

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: 09/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2024

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-20240913153942

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: 09/16/2024

NARRATIVE

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This is an amended copy of the report previously issued on 09/16/2024. After review of this complaint, it was determined corrections to the verbiage was warranted. The complaint findings remain the same.

Regarding the allegation: Unlawful Eviction. It is being alleged that the resident is being evicted for non-payment of rent. Eight (08) out of nine (09) residents were able to confirm that they are aware of the admission agreement, and they are also aware of the eviction rules. LPA’s interview with Resident #1 (R1) confirmed that they have never paid rent. R1 believed that the Assisted Living Waiver was paying their rent. The Assisted Living Waiver was only paying $108.00 of the portion of R1’s rent. R1’s admission to the above facility was on 07/17/23 with a monthly rent of $1324.82. The accumulation of non-payment of rent is over $7389.92 which was given to R1 in the form of an eviction notice. In addition, the administrator provided the resident with the proper reasoning of eviction notice of non-payment on 06/07/24. On June 07, 2024, LPA received the appropriate eviction notice of R1 via fax through Community Care Licensing Department (CCLD). LPA’s interview with the administrator confirmed that R1 refused to get their help and help from the Assisted Living Waiver program to find a new place to live. A lawful detainer was also given to R1. Three (3) out of three (3) staff confirmed that they were present when they served R1 with the appropriate eviction notice. LPA review of R1's admission agreement shows the amount of the rent of 1324.82 for a shared room and the admission agreement describes the eviction notice. Therefore, based on the LPA's record reviews, staff and resident’s interviews the above allegation(s) above is UNSUBSTANTIATED at this time.

Regarding the allegation: Facility staff financially abuse resident. It is being alleged that unauthorized purchases were made to the resident’s medical card. Eight (08) out of nine (09) residents confirmed that they have never had any financial abuse from the above facility or any unknown charges to their medical card. LPA’s interview with Resident #1 (R1) confirmed that they did not have a receipt of the financial abuse. In addition, LPA spoke to a worker at United Medical Supplies that delivers all the supplies, creates invoices, and bills the residents at the above facility and the witness stated, no delivery, invoice or billing was made to R1 for any diapers, bed pans, and/or paste on R1's medical card. Two (2) out of two (2) staff confirmed that no residents have been billed for any unauthorized purchases on their medical card. Therefore, based on the LPA's record reviews, staff and resident interviews the above allegation(s) above is UNSUBSTANTIATED at this time.

An exit interview was conducted, no citation(s) were issued for the above allegation(s), and a copy of this report was given to the Resident Care Director.

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Gina Saucedo	TELEPHONE: (818) 304-3057
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2024

LIC9099 (FAS) - (06/04)

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