197608267-12-14-2021-31-AS-EMIR-CCTU29-20220324151134

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 12/14/2021
Date Signed: 12/14/2021 11:56:44 AM

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
06/25/2021 and conducted by Evaluator Alexander Pitz

COMPLAINT CONTROL NUMBER: 31-AS-20210625171331

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:	09:00 AM
MET WITH:	Aris Vergara		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Staff member sexually assaulted resident.
Resident's privacy is not being observed by staff.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Pitz conducted an unannounced visit on this day for the purpose of delivering complaint findings for the Investigations Branch (IB).
During this investigation LPA Pitz conducted an initial visit to the facility on 6/29/21 and interviewed Resident 1 (R1) and the facility’s Administrator and Wellness Coordinator. Special Investigator Douglas conducted telephonic interviews with the facility Administrator and Los Angeles Police Department (LAPD) West Valley Division Detective Potter on 7/8/21 and 7/9/21; interviewed 5 residents on 8/18/21 at 1:30pm; reviewed the LAPD West Valley Division Investigative report on 9/1/21; interviewed staff 1 (S1) on 10/1/21 at 10:30am with the assistance of Special Investigator Assistant Sandoval; interviewed a relevant witness (W1) telephonically on 10/27/21 at 5:45pm; Interviewed the facility Wellness Coordinator on 11/10/21 at 12:30pm; interviewed a second relevant witness (W2) and the Administrator on 11/17/21; interviewed S1 on 11/24/21 at 5:00pm with the assistance of Special Investigator Assistant Sandoval.

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-20210625171331

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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The allegation that “Staff member sexually assaulted resident” has been unsubstantiated based on the interviews conducted and records reviewed. S1 denied having sexually assaulted Resident 1 (R1) during all 3/3 interviews conducted by the LAPD and IB, and no additional evidence was provided to support the allegation. Aside from those of the alleged perpetrator and victim, additional interviews conducted between 6/29/21 and 11/24/21 revealed that 2/2 staff, 5/5 residents, and 1/2 additional witnesses did not have any contemporaneous knowledge, evidence or suspicion that the allegation was true.

The allegation that "Resident's privacy is not being observed by staff," has been unsubstantiated based on the interviews conducted and records reviewed. S1 denied violating R1's privacy and provided only legitimate excuses for having to visit R1's room for maintenance reasons. Neither the complainant nor any of the additional interviewees contacted between 6/29/21 and 11/24/21 provided any additional corroborating evidence for the allegation, and 2/2 staff, 5/5 residents, and 1/2 additional witnesses did not have any contemporaneous knowledge, evidence or suspicion that the allegation was true

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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