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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 05/21/2025
Date Signed: 05/21/2025 12:50:01 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
05/09/2025 and conducted by Evaluator Gina Saucedo
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20250509144659
FACILITY NAME:CEDARS ASSISTED LIVING, THEFACILITY NUMBER:
197608267
ADMINISTRATOR:STEPHAN SARMAZIANFACILITY TYPE:
740
ADDRESS:17300 ROSCOE BLVD.TELEPHONE:
(818) 344-2042
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY:175CENSUS: 102DATE:
05/21/2025
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Mary Jane Reyes, Resident Care DirectorTIME COMPLETED:
12:50 PM
ALLEGATION(S):
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Staff are not meeting resident's care needs.
INVESTIGATION FINDINGS:
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On 05/21/25, at 10:20 AM, 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 05/12/25, LPA Saucedo conducted the initial visit. On 05/12/25, LPA Saucedo asked for the census, staff, and resident rosters. On 05/12/25, LPA Saucedo conducted a physical tour and interviewed staff. On 05/12/25, LPA Saucedo requested hospital records from Northridge Hospital.

LIC 9099C-continued
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025
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-20250509144659
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: 05/21/2025
NARRATIVE
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Regarding the allegation: Staff are not meeting resident's care needs. It is being alleged that staff are not providing adequate care and supervision to resident #1(R1). During LPA's record review of R1's medical records, It was revealed that R1 was severely dehydrated and had high levels of sodium resulting in hypernatremia. R1's sodium level was 176. Let it be noted, a normal sodium intake is between 136-145. LPA interviewed two (2) staff that confirmed that R1 was on Hospice. During LPA's record review of Hospice notes it showed that Hospice was at the facility every 14 (fourteen) days. LPA also interviewed Hospice Representative that stated R1 was not eating at the time of their last visit with them. During LPA's file review of R1 from the facility, it was observed that R1's last resident appraisal was completed on 11/30/2023. Based on the record reviews and staff/hospice interviews, it is being determined that the facility did not meet the resident's care needs therefore,the allegation(s) is SUBSTANTIATED at this time.

A Civil Penalty of $1000.00 is being issued today, due to this being a repeat violation. Refer to LIC 421M.



Exit interview conducted, appeal rights discussed, and a copy of the report was given to the Resident Care Director.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20250509144659
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: 05/21/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/22/2025
Section Cited
HSC
1569.269(a)(6)
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ยง1569.269 Enumerated rights; severability(a) Residents of residential care facilities for the elderly shall have all of the following rights:(6) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement is not met by:
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Licensee/Administrator will provide dementia training to all staff on the care, supervision and services to all residents.

POC Cleared 05/22/25
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Based on the LPA's Interviews the licensee/administrator failed to ensure the care, supervision and services of resident #1 (R1) while in the facility. This posed an immediate health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3