197608267-10-13-2021-31-AS-JMAZ-C7RTHA-20211013144426

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197608267
Report Date: 10/13/2021
Date Signed: 10/13/2021 02:44:53 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	CEDARS ASSISTED LIVING, THE		FACILITY NUMBER:	197608267
ADMINISTRATOR:	ARISTOTLE B. VERGARA		FACILITY TYPE:	740
ADDRESS:	17300 ROSCOE BLVD.		TELEPHONE:	(818) 344-2042
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91325
CAPACITY:	175	CENSUS: 103	DATE:	10/13/2021
TYPE OF VISIT:	POC	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Aris Vergara		TIME COMPLETED:	02:50 PM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

An unannounced Plan of Correction (POC) visit was conducted on this facility by Licensing Program Analysts (LPA’s) Joscelyn Martinez and Melissa Ruiz. The purpose of this visit is to follow up on the Plan of Corrections that were issued during annual visit conducted on 10/04/21 by LPAs Joscelyn Martinez, Yelena Avestisyan, and Gary Tan.

On 10/06/21 administrator Aris Vergara emailed plan of corrections, however according LPA Yelena Avestisyan, the plan of corrections were incomplete. As of today’s visit, the Administrator has failed to submit complete and accurate plan of corrections to the Department.

87202(a)(2)

All facilities shall maintain a fire clearance. Prior to accepting persons over 60 years of age none ambulatory and/or bedridden the licensee shall notify the licensing agency and obtain an appropriate fire clearance. This requirement is not met as evidenced by: This requirement is not met as evidenced by: Based on Based on observation and interview the licensee did not comply with the cited section by retaining 6 out of 7 bedridden residents in rooms that were do not have bedridden fire clearance which poses an immediate health, safety and personal rights risk to persons in care. (Room 106,136, 208, 221,242, 240,). For failure to submit plan of corrections a civil penalty $100 per day is hereby assessed for the period of 10/06/21 – 10/08/21 totaling $300 .

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Joscelyn Martinez	TELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: CEDARS ASSISTED LIVING, THE	FACILITY NUMBER: 197608267
	VISIT DATE: 10/13/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

87203

Fire Safety. All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement is not met as evidenced by: Based on observations made the licensee did not comply with the section cited above by locking designated exit doors with a key inside the residents’ rooms which poses and immediate health, safety or personal rights risk to persons in care. For failure to submit plan of corrections a civil penalty $100 per day is hereby assessed for the period of 10/06/21 – 10/13/21 totaling $800 .

87203

All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic.

This requirement is not met as evidenced by: Based on observations made the licensee did not comply with the section cited above by not ensuring smoke detectors are properly working throughout the facility which poses and immediate health, safety or personal rights risk to persons in care. For failure to submit plan of corrections a civil penalty $100 per day is hereby assessed for the period of 10/06/21 – 10/12/21 totaling $800 .

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Joscelyn Martinez	TELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021

LIC809 (FAS) - (06/04)

Page: 2 of 2