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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 10/21/2024
Date Signed: 10/21/2024 12:32:32 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
10/15/2024 and conducted by Evaluator Gina Saucedo
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20241015210021
FACILITY NAME:CEDARS ASSISTED LIVING, THEFACILITY NUMBER:
197608267
ADMINISTRATOR:KANDICE VERGARAFACILITY TYPE:
740
ADDRESS:17300 ROSCOE BLVD.TELEPHONE:
(818) 344-2042
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY:175CENSUS: 106DATE:
10/21/2024
UNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Mary Jane Reyes, Resident DirectorTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Staff did not release resident's records upon request from the resident
INVESTIGATION FINDINGS:
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On 10/21/24, at 8:55am, Licensing Program Analyst (LPAs) Gina Saucedo and Angelica Segovia 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 and deliver findings for this complaint.

On 10/21/24, LPA Saucedo asked for the census, staff, and resident rosters. On 10/21/24, LPA Saucedo interviewed staff and residents and conducted a physical tour.

LIC 9099C-continued

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy AgardTELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Gina SaucedoTELEPHONE: (818) 304-3057
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2024
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 2
Control Number 31-AS-20241015210021
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: 10/21/2024
NARRATIVE
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Regarding the allegation: Staff did not release resident's records upon request from the resident. It is being alleged that one (1) of the resident’s requested their ALW-Assisted Living Waiver paperwork and it was not being provided to them. Nine (9) out of ten (10) residents confirmed that staff do assist and provide them with necessary paperwork with proper notification. Resident #1 (R1) did confirm that at the time that they requested their paperwork they were not at the above facility, and they requested their paperwork via telephone. Two (2) out of two (2) staff confirmed that paperwork is confidential, needs to be done in person and/or by written request and given proper notification time. One (1) staff confirmed that if requests are done over the phone, they do not know the person’s identity so the request must still be done via email/written request. LPA was able to confirm that R1 has not been at the above facility since 08/10/24. Therefore, based on the LPA's observations, staff, and resident interviews the above allegation(s) 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 AgardTELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Gina SaucedoTELEPHONE: (818) 304-3057
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2024
LIC9099 (FAS) - (06/04)
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