197608267-2-5-2025-31-AS-TAGD-DEJP7N-20250307100414

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 02/05/2025
Date Signed: 02/05/2025 01:09:01 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
02/04/2025 and conducted by Evaluator Gina Saucedo

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20250204152339

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: 107	DATE:	02/05/2025
		UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Mary Jane Reyes, Resident Care Director		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Staff hit resident in care
Staff did not attend to resident's toileting needs in a timely manner
Staff did not safeguard resident's personal belongings

INVESTIGATION FINDINGS:

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On 02/05/25, at 9:35am, 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 gather information, interview staff and residents and deliver findings for this complaint.

On 02/05/25, LPA Saucedo asked for the census, staff, and resident rosters. On 02/05/25, LPA Saucedo conducted a physical tour and interviewed staff and residents.

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: 02/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025

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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Control Number 31-AS-20250204152339

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: 02/05/2025

NARRATIVE

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Regarding the allegation: Staff hit resident in care. It is being alleged that one (1) of the nurses flicked a finger on resident #1 (R1)'s head. During the review of R1' file, LPA discovered that this incident occurred June 04, 2023. It was reported to the Ombudsman, West Valley Police and Community Care Licensing Department (CCLD) on June 05, 2023, through a SOC 341 report. The West Valley Police was called the day of the incident June 04, 2023. An Unusual Incident/Injury Report was also provided to CCLD. LPA interviewed R1, and R1 was able to tell LPA what happened and mentioned it was a long time ago. LPA interviewed nine (9) other residents that confirmed Staff #1 (S1) and Staff #2 (S2) have never hit them. LPA interviewed S1 and S1 remembers the day of the incident because they were accused of hitting a resident which could not have happened because they worked in a different area of the facility that day in memory care and not in assisted living where R1 resides. When LPA interviewed staff #3 (S3), S3 confirmed that the incident occurred a long time ago and the incident was not proven to be true, and all documentation was reported. Based on the LPA's observations and record reviews, staff and resident interviews conducted the allegation is UNSUBSTANTIATED at this time.

Regarding the allegation: Staff did not attend to resident's toileting needs in a timely manner. It is being alleged that resident #1 (R1) is sitting in their own urine and feces all day. During LPA's interview with R1, R1 stated the caregivers only change them about three (3) times a day. During LPA's record review, LPA discovered that R1 is under the care of Orange Home Health for both medical and physical therapy. LPA obtained the Home Health schedule of R1. During LPA's physical tour, LPA observed R1 receiving services from Orange Home Health. During LPA's interview with two (2) staff, it was confirmed that R1 because of their incontinence, R1 gets changed several times a day and R1 can also request more incontinence changing if they need it. LPA interviewed nine (9) residents that confirmed their toileting needs are met in a timely manner. Based on the LPA's observations and record reviews, staff and resident interviews conducted the allegation is UNSUBSTANTIATED at this time.

LIC 9099C-continued

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Gina Saucedo	TELEPHONE: (818) 304-3057
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20250204152339

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: 02/05/2025

NARRATIVE

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Regarding the allegation: Staff did not safeguard resident's personal belongings. It is being alleged that resident #1 (R1)'s clothes have been stolen. During LPA's record review of R1, LPA obtained the Client/Resident Personal Property and Valuables sheet from their file with their signature. During LPA's physical tour, LPA cross-referenced the items on the sheet with what was in R1's room. LPA took pictures of different items in R1's room. LPA also took pictures of Amazon packages that have been delivered to R1. LPA interviewed R1, and R1 stated they order a lot of items from Amazon and have a lot of clothing but don't know where their clothing is located in the room. LPA interviewed nine (9) other residents that confirmed they do not have any issue with the safeguarding of their personal belongings. LPA interviewed one (1) staff that confirmed that all Client/Resident Personal Property and Valuables sheet are obtained during resident intake and throughout their stay. Based on the LPA's observations and record reviews, staff and resident interviews conducted the allegation 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: 02/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025

LIC9099 (FAS) - (06/04)

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