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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 07/14/2025
Date Signed: 07/14/2025 01:12:05 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
05/20/2025 and conducted by Evaluator Gina Saucedo
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20250520081630
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: 107DATE:
07/14/2025
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Mary Jane Reyes, Resident Care DirectorTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Staff not rotating resident resulting in pressure sores
Staff not providing resident with food
INVESTIGATION FINDINGS:
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On 07/14/25, at 9:55am, Licensing Program Analysts (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, interview staff and residents and deliver findings for this complaint.

On 05/21/25, LPA Saucedo conducted the initial visit. On 05/21/25, LPA Saucedo asked for the census, staff, and resident rosters. On 05/21/25, LPA Saucedo conducted a physical tour and interviewed staff. On 07/14/25, LPA’s Gina Saucedo and Angelica Segovia conducted another physical tour and interviewed additional staff.

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

DATE: 07/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2025
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 5
Control Number 31-AS-20250520081630
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: 07/14/2025
NARRATIVE
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Regarding the allegation: Staff not rotating resident resulting in pressure sores. It is being alleged that resident #1 (R1) had pressure sores on their back, buttocks, and shoulders. LPA Saucedo requested medical records from Northridge Hospital and the medical records confirmed that R1 did not have any pressure sores. LPA Saucedo also called the skilled nursing where R1 is currently located, and they also confirmed R1 did not have any pressure sores, and they are not treating R1 for any pressure sores. R1 was also under Mensa Hospice care while at the facility, and they also confirmed that R1 did not have any pressure sores and/or was not being treated for any pressure sores. In addition, LPAs received R1’s hospice notes that indicated R1 did not have any pressure sores. Furthermore, LPAs conducted three (3) staff interviews that confirmed R1 did not have any pressure sores. Therefore, based on the LPA's record reviews, medical records, hospice notes and staff interviews conducted, the allegation is UNSUBSTANTIATED at this time.


Regarding the allegation: Staff are not providing resident with food. It is being alleged that resident #1 (R1) was not being provided with food. Since R1 was under the Mensa Hospice Care, LPAs reviewed hospice notes that confirmed mechanical soft diet (puree-smooth foods) was being provided to R1 because R1 could not have normal food. LPAs interviewed three (3) staff that confirmed that R1 could not intake any hard food so R1 was being provided puree food such as Ensure. LPA Saucedo requested medical records from Northridge Hospital and the medical records confirmed Northridge that R1 was put on Intravenous therapy (IV) fluids and was provided G-tube feeding while in the hospital because R1 could not swallow any solid foods and failed the hospital swallow study conducted by the GI consult-Gastroenterologist which allowed R1 to be put on a G-tube. Therefore, based on the LPA's record reviews/medical records, hospice notes and staff interviews conducted, the allegation 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.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
05/20/2025 and conducted by Evaluator Gina Saucedo
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20250520081630

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: 107DATE:
07/14/2025
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Mary Jane Reyes, Resident Care DirectorTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Staff not providing resident with water
INVESTIGATION FINDINGS:
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On 07/14/25, at 9:55am, Licensing Program Analysts (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, interview staff and residents and deliver findings for this complaint.

On 05/21/25, LPA Saucedo conducted the initial visit. On 05/21/25, LPA Saucedo asked for the census, staff, and resident rosters. On 05/21/25, LPA Saucedo conducted a physical tour and interviewed staff. On 07/14/25, LPA’s Gina Saucedo and Angelica Segovia conducted another physical tour and interviewed additional staff.

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

DATE: 07/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 31-AS-20250520081630
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: 07/14/2025
NARRATIVE
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Regarding the allegation: Staff not providing resident with water. It is being alleged that resident #1 (R1) was not being provided with water. On May 4th, 2025, R1 was taken to Northridge hospital. Northridge medical records indicated that R1 was severely dehydrated and was thus admitted to the Intensive Care Unit (ICU). In addition, the Emergency Medical Services (EMS) that transported R1 to the hospital stated to the hospital that R1 was dehydrated. Furthermore, Intravenous fluid hydration had to be provided to R1 for the dehydration. Three (3) staff stated that they did not know R1 was dehydrated. Therefore, based on the LPA's record reviews/medical records 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: 07/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 31-AS-20250520081630
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: 07/14/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/15/2025
Section Cited
CCR
87705(b)(B)
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87705(b)(B) Care of Persons with Dementia (b)Licensees shall be responsible for the following: (B) Recognizing symptoms that may create or aggravate behavioral expression, as defined in Section 87101, Definitions, including, but not limited to, dehydration, urinary tract infections, and problems with swallowing; and This requirement is not met by:

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Licensee/Administrator will provide a statement of understanding regarding the title 22 regulation of 87705 Care of Persons with Dementia:

POC Cleared 07/15/25
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Based on the LPAs Interviews the licensee/administrator failed to ensure the behavioral expressions of resident #1 (R1) having severe dehydration while at 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: 07/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5