197608267-9-24-2024-31-AS-TAGD-D9US5P-20241008133442

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 09/24/2024
Date Signed: 09/24/2024 01:37:00 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
08/26/2024 and conducted by Evaluator Gina Saucedo

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20240826131516

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:	DATE:	09/24/2024
		UNANNOUNCED	TIME BEGAN:	08:55 AM
MET WITH:	Mary Jane Reyes-Resident Care Director		TIME COMPLETED:	01:50 PM

ALLEGATION(S):

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Resident sustained multiple pressure injuries while in care
Facility did not have sufficient staff to care for the residents
Staff failed to observe the resident resulting to multiple falls
Staff over medicated the resident in care
Staff did not re appraise the resident regularly while in care

INVESTIGATION FINDINGS:

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On 09/24/24, at 8:55am, Licensing Program Analyst (LPAs) Gina Saucedo and Angelica Segovia 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 and deliver findings for this complaint.

On 08/27/2024, Licensing Program Analyst (LPAs) Gina Saucedo and Angelica Segovia initiated the complaint investigation. On 08/27/24, LPA Saucedo and LPA Segovia asked for the census, staff, and resident rosters. On 09/24/24, LPA Saucedo interviewed additional staff and residents, conducted a physical tour, gathered additional information, and delivered findings.

LIC 9099-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: 09/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024

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-20240826131516

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: 09/24/2024

NARRATIVE

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Regarding the allegation: Resident sustained multiple pressure injuries while in care. It is being alleged that resident #1 (R1) sustained multiple pressure injuries while in care. R1 is no longer residing at the above facility. While in care of the above facility, R1 received one (1) wound care on their sacro coccyx right buttocks sacral area, pressure ulcer stage 3 and received hospice care from “Mensa” with the son’s authorization. Mensa Hospice Care had case notes describing the wound and the care of the wound. One (1) out of ten (10) residents confirmed that they have been in the hospital for pressure injuries, but they were returned to the above facility after they got the care they needed and confirmed that they have a history of heel injuries. Three (3) out of three (3) staff confirmed that if any type of injury occurs especially injuries that have to do with wounds they are sent to the hospital and upon their return to the above facility the resident is cared for on the doctor’s orders. Hospice or Home Health is recommended for the resident depending on the type of injury and/or medical condition they have. The other residents confirmed they have not received any pressure injuries while in care. Therefore, based on the LPA's records review, staff and resident interviews, the above allegation(s) is UNSUBSTANTIATED at this time.

Regarding the allegation: Facility did not have sufficient staff to care for the residents. It is being alleged that resident #1 (R1) was not being provided staffing to meet their needs. R1 is no longer residing at the above facility. R1 was in the memory care section of the above facility where there are two (2) caregivers and one (1) housekeeper per shift. R1 was also put under Mensa Hospice Care on June 18, 2024, so their needs could be met and have an additional staff providing care to them. Four (4) out of ten (10) residents confirmed that there is a need for more staff, but their care might be slow, but it still gets done. Three (3) out of three (3) staff confirmed that there are several staff to help the residents. In addition, Hospice and Home Health are recommended for the resident’s that need extra care. Therefore, based on the LPA's records review, staff and resident interviews, the above allegation(s) above is UNSUBSTANTIATED at this time.

LIC 9099C-continued

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Gina Saucedo	TELEPHONE: (818) 304-3057
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20240826131516

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: 09/24/2024

NARRATIVE

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Regarding the allegation: Staff failed to observe the resident resulting to multiple falls. It is being alleged that resident #1 (R1) fell multiple times and it resulted in stitches. R1 is no longer residing at the above facility. R1 fell twice since their stay at the above address. On 10/2023 and on 01/2023. Both falls were reported to CCLD-California Community Licensing Department and both times R1 was sent to the hospital. Northridge and Tarzana hospitals did not state that R1 needed any stitches for their fall and R1 was released back to the above facility. Ten (10) out of ten (10) residents confirmed that the staff have never failed to help them or left them unattended if they fell. Three (3) out of three (3) staff confirmed if a resident falls or an injury occurs with them the resident is transported to the hospital, an incident report is written, and sent to CCLD- California Community Licensing Department. Therefore, based on the LPA's records review, staff and resident interviews, the above allegation(s) is UNSUBSTANTIATED at this time.

Regarding the allegation: Staff over medicated the resident in care. It is being alleged that Resident #1 (R1) was sedated all day and would not get out of their bed. R1 is no longer residing at the above facility. R1’s paperwork confirms that R1 was bedridden and was taking multiple medications for their health. Ten (10) out of ten (10) residents confirmed that they have not been over medicated. Three (3) out of three (3) staff confirmed almost all their residents take medication and that the medication has different side effects and that to their knowledge a resident has not been sent to the hospital for being over medicated. Therefore, based on the LPA's records review, staff and resident interviews, the above allegation(s) is UNSUBSTANTIATED at this time.

LIC 9099C-continued

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Gina Saucedo	TELEPHONE: (818) 304-3057
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20240826131516

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: 09/24/2024

NARRATIVE

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Regarding the allegation: Staff did not reappraise the resident regularly while in care. It is being alleged that resident #1 (R1) was not appraised and reappraised to determine his or her individual needs and services. R1 is no longer residing at the above facility. R1 was admitted to the above facility in 2022. There was a pre-placement appraisal which indicated an ambulatory status on 05/2022. The Assisted Living Waiver indicates they had a history of falls which is dated 11/2022. R1’s Resident Information/Care Plan dated 08/2023 indicates they were now non-ambulatory, and their Physician Report 04/2023 also stated non-Ambulatory with history of falls. The updated paperwork from the hospitals showed R1 had become bedridden and there is an updated Resident Information/Care Plan that shows R1 was bedridden. The resident care director and administrator both stated that R1’s health had decreased while they lived at the above facility. On 09/14/23, R1 went to the hospital for a psychological evaluation and on 01/09/24, R1 went to the hospital again for a seizure. On 04/27/24, R1 was sent to the Northridge hospital, and they transferred R1 to a Woodland Hills Skilled Nursing Facility for further rehabilitation due to R1’s health. Woodland Hills Skilled Nursing discharged R1 back to the above facility in June 2024 with home health recommendation and R1 was placed under Hospice with son’s authorization on June 18, 2024. Ten (10) out of ten (10) residents confirmed that they are aware of their health changes, needs and services. Three (3) out of three (3) staff confirmed that the reappraisal happens when a resident’s health changes. The staff confirmed that the residents must go to the doctor for this to happen and the resident’s needs and services are then updated. One (1) of the staff also stated that R1’s health was deteriorating while in the care of the above facility. Therefore, based on the LPA's records review, 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, Mary Jane Reyes.

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Gina Saucedo	TELEPHONE: (818) 304-3057
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024

LIC9099 (FAS) - (06/04)

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