197608267-1-22-2025-31-AS-TAGD-DDJTRL-20250203135740

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 01/22/2025
Date Signed: 01/22/2025 10:30:05 AM

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
01/06/2025 and conducted by Evaluator Gina Saucedo

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20250106131753

FACILITY NAME:	CEDARS ASSISTED LIVING, THE		FACILITY NUMBER:	197608267
ADMINISTRATOR:	KANDICE VERGARA		FACILITY TYPE:	740
ADDRESS:	17300 ROSCOE BLVD.		TELEPHONE:	(818) 344-2042
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91325
CAPACITY:	175	CENSUS: 101	DATE:	01/22/2025
		UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Mary Jane Reyes- Resident Care Director		TIME COMPLETED:	10:25 AM

ALLEGATION(S):

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Staff did not properly report incidents involving residents

INVESTIGATION FINDINGS:

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On 01/22/25, at 9:25am, 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 deliver findings for this complaint. On 01/09/25, LPA Segovia conducted an initial complaint and asked for the census, staff, and resident rosters.
Regarding the allegation: Staff did not properly report incidents involving residents. It is being alleged a Community Care Licensing (CCLD) employee confirmed no SOC 341 was received by the facility for this alleged abuse. On 01/30/24, LPA Saucedo investigated complaint # 31-AS-20240123163901 regarding an incident related to the SOC 341 that was allegedly not reported to licensing. In the complaint received on 01/23/24, was attached the SOC 341. In addition, there was an Unusual Incident/Injury Report sent to Community Care Licensing Department on 01/23/2024 by facility confirming the incident that took place. During an interview with the CCLD employee, they did not recall providing confirmation that an SOC 341 was or was not received. Therefore, based on the LPA's record review and staff interview 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.

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: 01/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025

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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