197608267-1-22-2025-31-AS-TAGD-DDJUXA-20250203145802

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 01/22/2025
Date Signed: 01/22/2025 01:39:53 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
01/21/2025 and conducted by Evaluator Gina Saucedo

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20250121102152

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:	01:26 PM
MET WITH:	Kandace Vergara		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Staff did not intervene when a resident-on-resident assault occurred

INVESTIGATION FINDINGS:

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On 01/22/25, at 1:25pm, Licensing Program Analyst (LPA) Gina Saucedo 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 interview staff and residents and deliver findings for this complaint.
Regarding the allegation: Staff did not intervene when a resident-on-resident assault occurred. It is being alleged that resident #1 (R1) was repeatedly hit on their head with a cell phone by another resident and staff did not intervene. LPA interviewed two (2) staff that confirmed that R1 was relocated from the Pasadena Fires (Pasadena Villa Senior Living Facility 198603286) and is residing at Cedars Assisted Living temporarily. Staff #1 (S1) confirmed that R1’s assault was reported and R1 was thus sent to the hospital for their injuries. S1 also confirmed that R1 was hit by another resident from the Pasadena Villa Senior Living Facility and not a Cedars Assisted Living resident. Therefore, based on the LPA's record review and staff 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 Administrator.

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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