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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608267
Report Date: 10/11/2021
Date Signed: 10/11/2021 01:22:59 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:CEDARS ASSISTED LIVING, THEFACILITY NUMBER:
197608267
ADMINISTRATOR:ARISTOTLE B. VERGARAFACILITY TYPE:
740
ADDRESS:17300 ROSCOE BLVD.TELEPHONE:
(818) 344-2042
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY:175CENSUS: 104DATE:
10/11/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Aris Vergara TIME COMPLETED:
01:35 PM
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At 11:40 am, Licensing Program Analysts (LPA’s) Joscelyn Martinez and Melissa Ruiz conducted an unannounced case management visit to the facility to follow up on an incident that happened on 10/6/21, where resident #1 (R1) went missing. LPA’s met with the Administrator Aristotle Vergara.

The incident report stated the R1 was last seen at 3:00 pm during the weekly covid-19 mass testing, and a ground check was conducted between 4:30 - 5:00 pm. The police were called and arrived at the facility later that night, at approximately 9:00 pm. Police got a hold of R1 on Thursday, 10/7/21 through his cellphone and R1 told the police he decided to leave the facility at his own will.

LPA’s interviewed the Administrator, Aristotle Vergara. LPA’s Administrator interview revealed, R1 was physically seen in South Central on 10/08/21 and police took R1 into 77th Local Street Community Police Station. At the station, R1 refused to return to the facility and police stated they would conduct a psychiatric evaluation. Today, at approximately 10:30 am, resident care director, Lourdes Kazdan received a call from a board and care facility, Quartz Garden advising them that the R1 is now at that facility and requested to pick up R1’s medications. Administrator is waiting to hear back from R1’s responsible party to know whether or not they are aware R1 decided to move to a new facility. At approximately 12:27 pm, LPA’s attempted to contact R1 multiple times however LPA’s were unsuccessful

At approximately 12: 40 pm, LPA’s contacted Quartz Haven licensee Jeff Alvarez to confirm resident was at this facility. Licensee did in fact confirm R1 was at this facility and is receiving care and supervision.

Based on the evidence obtained during today’s visit, LPA’s concluded facility Administrator acted accordingly upon knowledge of resident missing.

No citation issued, exit interview conducted and a copy of the report was provided.

SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Joscelyn MartinezTELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2021
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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