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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 06/30/2025
Date Signed: 06/30/2025 10:57:12 AM

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
06/26/2025 and conducted by Evaluator Gina Saucedo
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20250626103110
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: 105DATE:
06/30/2025
UNANNOUNCEDTIME BEGAN:
09:28 AM
MET WITH:Mary Jane Reyes, Resident Care DirectorTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Staff did not ensure resident's catheter needs were being met.
INVESTIGATION FINDINGS:
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On 06/30/25, at 9:28am, 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 explained the purpose of this visit was to gather information, interview staff and residents and deliver findings for this complaint.

On 06/30/25, LPA Saucedo asked for the census, staff, and resident rosters. At 9:35am, LPA Saucedo conducted a physical tour and interviewed staff.

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

DATE: 06/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2025
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-20250626103110
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: 06/30/2025
NARRATIVE
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Regarding the allegation: Staff did not ensure resident's catheter needs were being met. It is being alleged that resident #1 (R1)’s catheter was plugged and R1 was experiencing urinary retention. LPA interviewed staff #1 (S1) and staff #2 (S2) who confirmed that R1 has a difficult time managing their catheter needs. LPA asked for Home Health, Hospice and/or skilled professional documentation that would show R1 was being helped/being provided assistance with their catheter. S1 and S2 confirmed that R1 was not under any skilled professional help. Let it be noted, that R1 is diagnosed with dementia, traumatic brain injury and altered mental status and is not physically and mentally capable of caring for their catheter. Additionally, LPA received R1’s Physician’s Report and Resident Appraisal. In addition, Valley Presbyterian Hospital confirmed that R1 now needed treatment for renal failure and UTI-Urinary Tract Infection. Therefore, based on the LPA's record reviews and staff interviews conducted the allegation is SUBSTANTIATED at this time.

An exit interview was conducted, citation(s) were issued, appeal rights were provided, and a copy of this report was given to the resident care director.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20250626103110
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: 06/30/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/01/2025
Section Cited
CCR
87623(a)(1)
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(a) The licensee shall be permitted to accept or retain a resident who requires the use of an indwelling catheter under the following circumstances: (1) If the resident is physically and mentally capable of caring for all aspects of the condition except insertion and irrigation.
This requirement is not met by:
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Licensee/Administrator will seek skilled professional help for Resident #1 (R1).

The POC was cleared at time of visit. R1 is now under American Home care Health Services.

POC Cleared 06/30/25
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Based on the LPA's Interviews the licensee/administrator failed to ensure that resident #1 (R1) was under the care of a skilled professional to help with their catheter. 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: 06/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3