197608267-10-30-2024-31-AS-TAGD-DC4PV9-20241219103846

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 10/30/2024
Date Signed: 10/30/2024 01:01:44 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
07/21/2023 and conducted by Evaluator Gina Saucedo

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20230721090852

FACILITY NAME:	CEDARS ASSISTED LIVING, THE		FACILITY NUMBER:	197608267
ADMINISTRATOR:	ARISTOTLE B. VERGARA		FACILITY TYPE:	740
ADDRESS:	17300 ROSCOE BLVD.		TELEPHONE:	(818) 344-2042
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91325
CAPACITY:	175	CENSUS: 106	DATE:	10/30/2024
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Mary Jane Reyes, Resident Care Director		TIME COMPLETED:	01:05 PM

ALLEGATION(S):

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Staff did not seek timely medical attention for a resident in care
Unqualified staff dispensing medication
Staff not assisting resident with incontinence needs
Staff did not assist resident with showering
Staff not responding to resident's call button timely
Staff did not afford resident respect in their relationship
Staff not allowing POA into facility

INVESTIGATION FINDINGS:

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On 10/30/24, at 8:45am, 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 and deliver findings for this complaint.

On 07/25/2023, Licensing Program Analyst (LPA) Tuesday Cabiness initiated the complaint investigation. On 10/30/24, LPA Saucedo asked for the census, staff, and resident rosters. On 10/30/24, LPA Saucedo interviewed additional staff, residents and conducted a physical tour.

LIC 9099C-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: 10/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024

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-20230721090852

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: 10/30/2024

NARRATIVE

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Regarding the allegation: Staff did not seek timely medical attention for a resident in care. It is being alleged that staff did not immediately call 911 for a resident #1 (R1). R1 is no longer residing at the above facility. Ten (10) residents confirmed that staff do seek medical attention for them in a timely manner. Two (2) staff confirmed that it is staff’s duty to seek timely medical attention for each resident and ensure their well being. Furthermore, one (1) of the caregivers did state that when R1 would call for assistance in the middle of the night they would respond to them several times; In addition, they were the staff that called 911 and sent R1 to the hospital on July 13, 2023. LPA was able to confirm that an Unusual Injury/Incident report was sent to CCLD-Community Care Licensing Department regarding R1 seeking medical attention and the caregiver calling 911 for R1. Therefore, based on the LPA's record reviews, staff and resident interviews the above allegation(s) above is UNSUBSTANTIATED at this time.

Regarding the allegation: Unqualified staff dispensing medication. It is being alleged that unqualified staff were dispensing incorrect medication. Three (3) staff confirmed that they do receive training to dispense medication. LPA was able to obtain training records for staff that dispense medication. LPA also confirmed that resident # 1 (R1) was under Palliative Care and Roze Room Palliative Care was distributing medication to R1 in addition to the staff working at the above facility. LPA obtained the Chart/Clinical notes provided by Roze Room Palliative Care regarding R1. Ten (10) residents confirmed that they do not have any issues with staff dispensing medication to them. Therefore, based on the LPA's record reviews, staff and resident interviews the above allegation(s) above is UNSUBSTANTIATED at this time.

Regarding the allegation: Staff not assisting resident with incontinence needs. It is being alleged that staff was leaving resident #1 (R1) in soiled diapers. R1 is no longer residing at the above facility. Ten (10) residents that require incontinence needs were interviewed and confirmed that they are not left in soiled diapers. In addition, eight (8) of these residents receive home health/hospice care which provides that extra service of assisting the resident. LPA’s interview with Power of Attorney and Palliative Care notes confirmed that R1 did not want to accept hospice care. Two (2) staff confirmed that R1 was provided an extra staff from the above facility to help assist them with incontinence and other needs. Therefore, based on the LPA's record reviews, staff and resident interviews the above allegation(s) above is UNSUBSTANTIATED at this time.

LIC9099C-continued

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Gina Saucedo	TELEPHONE: (818) 304-3057
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20230721090852

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: 10/30/2024

NARRATIVE

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Regarding the allegation: Staff did not assist resident with showering. It is being alleged that resident #1 (R1) did not shower for a month. R1 is no longer residing at the above facility. Ten (10) residents confirmed that they get a shower two (2) or three (3) times a week. Eight (8) out of these residents confirmed that they are provided help with showers from either home health or hospice care. LPA’s interview with Power of Attorney and record review confirmed that R1 did not want to accept hospice care but R1 was under Roze Room Palliative Care. Two (2) staff confirmed that R1 was provided an extra staff from the above facility to help assist them with their shower and other needs. Therefore, based on the LPA's record reviews, staff and resident interviews the above allegation(s) above is UNSUBSTANTIATED at this time.

Regarding the allegation: Staff not responding to resident's call button timely. It is being alleged that staff were not responding to resident #1 (R1)'s call button in a timely manner. R1 is no longer residing at the above facility. Ten (10) residents confirmed that staff do respond to a resident’s call button in a timely manner. Three (3) staff confirmed that they respond to all call buttons in a timely manner. Therefore, based on the LPA's record reviews, staff and resident interviews the above allegation(s) above is UNSUBSTANTIATED at this time.

Regarding the allegation: Staff did not afford resident respect in their relationship. It is being alleged that resident #1 (R1) was not shown respect in their relationships. R1 is no longer residing at the above facility. LPA spoke to R1’s Power of Attorney (POA) and POA confirmed that they had no issues visiting and/or having any relationship concerns when visiting or speaking to R1. LPA also confirmed with Roze Room Palliative Care about their visits and/or speaking with R1 at the above facility and they did not recall having any issues with the above facility. Two (2) staff confirmed that privacy is given to all residents. Ten (10) residents confirmed that they have no issues at the above facility with receiving visits or any type of relationships concerns. Therefore, based on the LPA's record reviews, staff and resident interviews the above allegation(s) above is UNSUBSTANTIATED at this time.

LIC9099C-continued

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Gina Saucedo	TELEPHONE: (818) 304-3057
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20230721090852

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: 10/30/2024

NARRATIVE

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Regarding the allegation: Staff not allowing POA into facility. It was alleged that the staff were not allowing resident #1 (R1)’s Power of Attorney (POA) into R1’s room. R1 is no longer residing at the above facility. LPA spoke to R1’s POA and the POA confirmed that they were allowed to enter R1’s room with five (5) other people to retrieve all of R1’s belongings. LPA interviewed ten (10) residents that confirmed their POA and/or family members have rights to their room as long as they give them permission. Two (2) staff confirmed that if the permission is given by a resident to enter their room the staff will allow others to enter their room. Therefore, based on the LPA's record reviews, 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.

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Gina Saucedo	TELEPHONE: (818) 304-3057
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024

LIC9099 (FAS) - (06/04)

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