197608267-12-14-2021-31-AS-EMIR-CBBT2C-20220204132027

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 12/14/2021
Date Signed: 12/14/2021 02:18:27 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
08/26/2020 and conducted by Evaluator Alexander Pitz

COMPLAINT CONTROL NUMBER: 31-AS-20200826144744

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 took resident's personal items
Staff does not ensure resident's dietary needs are met
Staff locked resident in their room

INVESTIGATION FINDINGS:

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

As part of this investigation LPA Berry interviewed the complainant and Resident 1 (R1) on 9/04/20; conducted a virtual tour and interviewed a facility staff member on 9/4/20. LPA Pitz interviewed R1, the facility administrator, two staff members and 11 residents on 12/14/21 at 10:00am.

Allegation #1, that "Staff took resident's personal items," has been unsubstantiated based on the interviews conducted. LPA Berry did not obtain any corroborating evidence from the complainant or R1 on 9/4/20, and LPA Pitz was not able to obtain any corroborating evidence after interviewing R1, the administrator or staff on 12/14/21. Both R1 and staff told LPA on 12/14/21 that none of the police reports filed by R1 resulted in any charges being filed.

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-20200826144744

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 does not ensure resident's dietary needs are met" has been unsubstantiated based on the interviews conducted and observations made. On 9/4/20 R1 told LPA Berry that they were receiving meal service in their room. On 12/14/21 at 11:00am LPA reviewed R1's file and did not observe any evidence that R1 was supposed to receive a special diet. LPA interviewed R1 and 11 other residents on 12/14/21 and both R1 and the 11/11 residents interviewed confirmed that they are receiving appropriate meal service at the facility.

Allegation #3, that "Staff locked resident in their room," has been unsubstantiated based on the interviews conducted and observations made. On 9/4/20 LPA Berry interviewed R1, who stated that they are asked to stay in their room by staff in accordance with the facility's Covid outbreak mitigation procedures. A virtual tour conducted by LPA Berry on 9/4/20 confirmed that resident rooms only lock from the inside and not the outside. On 12/14/21 LPA toured the facility and did not observe any evidence that residents are locked in their rooms. 11/11 residents interviewed and 3/3 staff interviewed denied the allegation.

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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