197608267-1-17-2025-31-AS-ASEA-DCZPKK-20250117102317

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197608267
Report Date: 01/17/2025
Date Signed: 01/17/2025 10:23:25 AM

Document Has Been Signed on 01/17/2025 10:23 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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
ADMINISTRATOR/ DIRECTOR:	KANDICE VERGARA		FACILITY TYPE:	740
ADDRESS:	17300 ROSCOE BLVD.		TELEPHONE:	(818) 344-2042
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91325
CAPACITY: 175	TOTAL ENROLLED CHILDREN: 0	CENSUS: 159	DATE:	01/17/2025
TYPE OF VISIT:	Case Management - Health Checks	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:29 AM
MET WITH:	Mary Jane Reyes- Resident Care Director		TIME VISIT/ INSPECTION COMPLETED:	10:30 AM

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On 1/17/25 Licensing Program Analyst, (LPA) Angelica Segovia, conducted an unannounced visit to the facility to check on the residents who were evacuated due to the current wildfires that took place. LPA was greeted by Activities Director, Tabetha Whitehall. LPA stated the reason for their visit. The Administrator from Pasadena Villa Senior Living, Alexander Solorio assisted with today’s visit. Resident Care Director, Mary Jane Reyes arrived shortly after.

The facility accepted a total of forty-eight (48) residents from Pasadena Villa Senior Living (198603286), from the Monterey Park Regional Office. The facility had a mandatory evacuation due to the wildfires. The residents transported to this facility were transported with their medication and additional staff to assist. A physical plant tour was conducted to ensure the health and safety of residents.

LPA observed the following:

Relocated residents: Out of the forty-eight (48) residents, five (5) are in the Dementia Care unit of the facility, Willow on the first floor. Forty-three (43) residents are living in the Assisted Living Unit of the facility.

Evacuated residents have been placed in appropriate shared or single rooms with proper bedding, nightstand, chair, and lighting. LPA observed bedding and furniture in proper condition. Sufficient supplies of hygiene observed for residents. All sharps and toxins observed locked and inaccessible to residents. LPA observed residents in various units such as: dining room, activity rooms, media room, and outside shaded areas with sufficient seating.

LIC 809C-continued

Troy Agard	TELEPHONE: (818) 596-4342
Angelica Segovia	TELEPHONE: (818) 669-6375
	DATE: 01/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 01/17/2025

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The Kitchen: LPA observed sufficient stock of seven (7) day non-perishable and two (2) day perishable foods. LPA observed such items as canned goods, bread, milk, eggs, and variety of meats. LPA observed additional chairs and tables had been ordered and placed in the dining area to accommodate the additional residents who were transferred. Administrator stated they were able to transfer food from their home facility to help accommodate during evacuation orders. LPA observed the weekly menu which showcased a variety of meal options for breakfast, lunch, and dinner.

Fire drill: Last fire drill was conducted 10-5-2024. LPA observed multiple fire extinguishers located throughout the facility dated 11-13-24. The last annual was completed on 11-13-24. No immediate health or safety issues were observed during the annual. The Fire alarms and Carbon Monoxide detectors were last tested on 1-13-25 and noted to be in good condition and working properly.

No immediate health and safety issues observed. Exist interview conducted and a copy of this report was given to the Resident Care Director.

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Angelica Segovia	TELEPHONE: (818) 669-6375
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2025

LIC809 (FAS) - (06/04)

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