197608267-9-29-2026-31-AS-NMAN-DYSV2S-20261012160336

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 09/29/2026
Date Signed: 09/29/2026 02:42:57 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
03/12/2026 and conducted by Evaluator Antonia Alvizar-Ettima

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20260312115719

FACILITY NAME:	CEDARS ASSISTED LIVING, THE		FACILITY NUMBER:	197608267
ADMINISTRATOR:	DAVID AGUINIGA		FACILITY TYPE:	740
ADDRESS:	17300 ROSCOE BLVD.		TELEPHONE:	(818) 344-2042
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91325
CAPACITY:	175	CENSUS: 130	DATE:	09/29/2026
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Mary Jane Reyes, Resident Care Director (RCD)		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not meet a resident's hygiene needs
Staff forged a resident's signature on unauthorized documents
Staff do not respond timely to a resident's alerts
Staff isolate a resident while in care

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

At 10:30a.m., Licensing Program Analyst (LPA) Antonia Alvizar-Ettima conducted an unannounced subsequent complaint visit to deliver the findings regarding the above allegations. LPA met with the Resident Care Director (RCD), Mary Jane Reyes and explained the reason for the visit.

At approximately 11:05a.m., LPA and RCD conducted a physical plant walk through, to assess compliance with rules and regulations under California Code of Regulations, Title 22, Division 6. LPA reviewed additional records previously provided by the RCD.

An initial complaint investigation visit was conducted on 03/17/26. During the initial visit, LPA conducted interviews with the RCD, Staff #1 through Staff #3 (S1-S3), and twelve (12) residents including Resident #1 (R1). LPA and RCD also conducted a physical plant inspection. LPA obtained R1’s Identification Information, Admission Agreement, Physician Report, and other pertinent records relevant to the
Cont. on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2026

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

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 31-AS-20260312115719

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: 09/29/2026

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

Cont. from LIC 9099

investigation.
Staff did not meet a resident's hygiene needs
It was alleged that R1 was not bathed properly or frequently enough and was observed with dried feces clothing and body odor consistent with urine and feces. R1 reported receiving assistance with showers approximately twice per week and as needed. R1 stated that on some occasion R1 declines a shower because the weather was cold. Staff interviewed reported that R1 requires assistance with personal hygiene and that staff provide assistance with bathing and other hygiene needs. Records reviewed indicated that R1 receives assistance with bathing and personal care. Residents interview reported that staff assist residents with hygiene needs and did not report observing residents whose hygiene needs were not being addressed.
Based on interviews conducted and record reviewed, there is insufficient evidence to establish that staff failed to meet R1’s hygiene needs. Therefore, the allegation is UNSUBSTANTIATED at this time.

Staff forged a resident's signature on unauthorized documents

It was alleged that facility staff misled R1 into signing documents and/or forged R1's signatures or initials on documents without authorization. R1 reported that issue was resolved and was unable to provide specific details. The RCD denied that staff forged residents’ signatures and stated that residents may refuse to sign documents. S1 stated having no knowledge of staff forging resident signature. S1 further stated that when a resident refuses to sign a document, staff documents that the resident refused to sign. S2 provided information consistent with the RCD and S1 and stated that staff documents a resident's refusal when a resident declines to sign. Residents interviewed reported that staff explained documents prior to requesting signature and did not report witnessing staff forged resident signature.

Based on interviews conducted and information obtained during the investigation, there is insufficient evidence to establish that facility staff forge R1 signature or initials on unauthorized documents. Therefore, the allegation is UNSUBSTANTIATED at this time.

Cont. on LIC 9099-C

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 31-AS-20260312115719

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: 09/29/2026

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

Cont. from LIC 9099-C

Staff do not respond timely to a resident's alerts

It was alleged that staff frequently took 30 minutes or longer to respond when R1's requested assistance. During inspection, LPA randomly activated several residents including R1’ s call buttons located inside residence rooms LPA observed that the call buttons were functional and that staff responded within approximately six (6) to nine (9) minutes. R1 reported that staff respond to R1’s calls for assistance in a timely manner. Staff interviews reveal that resident call alerts are transmitted to cordless phones carried by staff. Staff stated that during the day, incoming calls are also received by the front desk and during the night shift, the Medication Technician monitors incoming call alerts. Staff reported that appropriate personnel are then contacted to help residents in care. Staff further stated that walkie-talkies are used to communicate regarding residents’ requests. The RCD stated that management conducts periodic checks to ensure staff are responding to residents call alerts. Residents interview also reported that staff respond to their requests for assistance in a timely manner.

Based on observation and interviews conducted there is insufficient evidence to establish that staff failed to respond timely to R1’s calls for assistance. Therefore, the allegation is UNSUBSTANTIATED at this time.

Staff isolate a resident while in care

It was alleged that the staff repeatedly closed R1’s bedroom door, Limiting R1's ability to call for assistance. During the inspection, LPA observed R1’s bedroom door in the open position. R1 reported that staff sometimes close the bedroom door; however, R1 was unable to provide specific information regarding when or under what circumstances staff close the door. R2, who shares the bedroom with R1 reported preferring the bedroom door to remain closed at night while sleeping. Other residents interview revealed that staff would not isolate residents and stated that residents are not confined to their bedrooms.

Based on observation and interviews conducted, there is an insufficient evidence to establish that staff isolated R1 while in care. Therefore, the allegation is UNSUBSTANTIATED at this time.

No immediate health and safety issues were noted.

Exit interview was conducted and copy of was provided.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 3