197608267-4-8-2025-31-AS-TAGD-DFMUGK-20250411153428

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 04/08/2025
Date Signed: 04/08/2025 11:45:49 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
01/09/2025 and conducted by Evaluator Gina Saucedo

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20250109101010

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:	04/08/2025
		UNANNOUNCED	TIME BEGAN:	11:25 AM
MET WITH:	Jolene Halog, Medication Technician		TIME COMPLETED:	11:50 AM

ALLEGATION(S):

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Resident sustained multiple pressure injuries due to lack of care from staff

INVESTIGATION FINDINGS:

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On 04/08/25, at 11:25am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, subsequent complaint visit and was greeted by Medication Technician, Jolene Halog. LPA explained the purpose of this visit was to deliver findings for this complaint.

On 01/09/25, the complaint was referred to The Community Care Licensing Investigations Branch (IB) and accepted as a full investigation. It was assigned to Investigator, Edward Hector. On 01/09/25, LPA Angelica Segovia initiated the twenty-four (24) hour complaint investigation. LPA asked for the census, staff, resident roster and pertinent documents.

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: 04/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2025

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-20250109101010

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: 04/08/2025

NARRATIVE

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Regarding the allegation: Resident sustained multiple pressure injuries due to lack of care from staff. It is being alleged that resident #1 (R1) sustained multiple pressure injuries (including an unstageable ulcer on their left hip) while in care of the facility.

On 01/23/25, at 07:29am, IB Investigator subpoenaed Kaiser Permanente’s, Release of Information (ROI) Unit, for the medical records of R1 but had to resend the subpoena on 01/24/25. The medical records were not received until 02/25/25. According to the medical records, R1 had a “history of unstageable pressure ulcer to right ankle and stage 3 pressure ulcer to left sacrum. On 01/23/25, at 10:51am, IB Investigator subpoenaed the Comcare Home Health main office for medical records of R1. On 02/14/25, multiple emails containing the home health records of R1 were received. According to the records, from November 7, 2024, to January 5, 2025, both home health nurse and facility caregivers confirmed that R1 would regularly move around, after being repositioned, and return to a position that was comfortable for them. The home health nurse advised that facility staff provided adequate supervision as evidence that they would come daily at “random” times and R1 always had a clean diaper, bed pad, and bed linens. Facility staff attributed to R1’s lack of healing to poor circulation of R1 being bed bound. There is not enough evidence to support the allegation that a lack of care caused R1 to develop pressure injuries. Therefore, based on the observation, record review, interviews conducted by the IB Investigator, the allegation is UNSUBSTANTIATED at this time.

Exit interview was conducted, no citation(s) were issued for the above allegation(s) and a copy of this report was given to the Medication Technician, Jolene Halog.

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Gina Saucedo	TELEPHONE: (818) 304-3057
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2025

LIC9099 (FAS) - (06/04)

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