197608267-3-11-2025-31-AS-TAGD-DF6NJ3-20250327102939

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 03/11/2025
Date Signed: 03/11/2025 02:12:46 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
03/05/2025 and conducted by Evaluator Gina Saucedo

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20250305101719

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: 109	DATE:	03/11/2025
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Mary Jane Reyes, Resident Care Director		TIME COMPLETED:	02:25 PM

ALLEGATION(S):

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Resident sustained multiple unexplained injuries while in care.
Residents are required to perform housekeeping duties.

INVESTIGATION FINDINGS:

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On 03/11/25, at 9:20am, 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 03/11/25, LPA Saucedo asked for the census, staff, and resident rosters. On 03/11/25, 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: 03/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025

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-20250305101719

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: 03/11/2025

NARRATIVE

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Regarding the allegation: Resident sustained multiple unexplained injuries while in care. It is being alleged that resident #1 (R1) has received multiple, unexplained injuries. Let it be noted, that R1 was relocated from the Pasadena Fires (Pasadena Villa Senior Living Facility 198603286) and is residing at Cedars Assisted Living temporarily. LPA interviewed R1 and R1 said they fell by the patio area in between the dining hall and the inside bathroom but does not remember who helped them get up. LPA interviewed staff #1 (S1) and S1 stated that R1 was found by the bathroom in the hallway by the lobby. S1 also stated, they called 911 and R1 was taken to the hospital. Let it be noted, this is the first incident that involved a staff that works for Cedars Assisted Living and R1. Therefore, based on the LPA's record review, staff and resident interviews, the above allegation(s) above is UNSUBSTANTIATED at this time.

Regarding the allegation: Residents are required to perform housekeeping duties. It is being alleged that resident #1 (R1)’s room is not being cleaned. Let it be noted, that R1 was relocated from the Pasadena Fires (Pasadena Villa Senior Living Facility 198603286) and is residing at Cedars Assisted Living temporarily. LPA interviewed R1 that confirmed their room is not cleaned every day. LPA interviewed resident #2 (R2), R1's roommate to confirm if their room is being cleaned and R2 stated, "yes, it is cleaned weekly." LPA interviewed eight (8) more residents that confirmed their room is cleaned weekly not every day. LPA interviewed staff #2 (S2) and staff #3 (S3) that stated the rooms are assigned to be cleaned on a weekly basis not every day. In addition, they can request another cleaning that same week if there is an accident or mess. Let it be noted, that R1's room is being cleaned by S2 who is one (1) of the housekeepers that works with Pasadena Villa Senior Living. R1's and R2's room is scheduled to be cleaned every Sunday. During LPA's physical tour, LPA observed R1 and R2's room to be clean. Therefore, based on the LPA's record review, observations staff and resident interviews, the above allegation(s) above is UNSUBSTANTIATED at this time.

An exit interview was conducted, no citation(s) were issued, 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: 03/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025

LIC9099 (FAS) - (06/04)

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