197608267-12-14-2021-31-AS-EMIR-CB52XY-20220128164751

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 12/14/2021
Date Signed: 12/14/2021 02:17:34 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
08/14/2020 and conducted by Evaluator Alexander Pitz

COMPLAINT CONTROL NUMBER: 31-AS-20200814162516

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: 109	DATE:	12/14/2021
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Aris Vergara		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff did not bathe resident.
Staff did not safeguard resident's money.
Staff refused to assist resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Pitz conducted an unannounced visit on this day in response to the above allegations.

During this investigation, LPA interviewed the administrator on 8/19/20; conducted a facility tour and interviewed two staff members, 11 residents, the complainant, and 1/2 relevant witnesses on 12/14/21 at 10:00am.

Allegation #1, that "Staff did not bathe resident," has been unsubstantiated based on the interviews conducted and observations made. During an inspection of Resident 1's (R1's) room at approximately 11:30am LPA did not observe any indication that R1 was not being bathed. R1's caseworker denied observing or hearing of any indication that R1 was not being bathed at the facility at approximately 12:00pm. 10/11 residents interviewed at 10:00am stated that they do not have any concerns with the bathing assistance provided by the facility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Alexander Pitz	TELEPHONE: (805) 450-1627
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2021

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-20200814162516

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 12/14/2021

NARRATIVE

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Allegation #2, that "Staff did not safeguard resident's money," has been unsubstantiated based on the interviews conducted. The complainant was unable to provide any corroborating evidence to support this allegation, and 9/11 residents interviewed denied having any similar issues or problems at the facility. The administrator and 2/2 staff interviewed stated that they had no knowledge of the allegation.

Allegation #3, that "Staff refused to assist resident" has been unsubstantiated based on the interviews conducted. The complainant was unable to provide any corroborating evidence to support this allegation, and 8/11 residents interviewed expressed no issues or concerns with the level of assistance they receive from staff.

Report reviewed, signed and delivered. Exit interview conducted, no deficiencies cited.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Alexander Pitz	TELEPHONE: (805) 450-1627
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2021

LIC9099 (FAS) - (06/04)

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