197608267-12-14-2021-31-AS-EMIR-CCTLUN-20220324090411

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 12/14/2021
Date Signed: 12/14/2021 02:19:04 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
09/03/2020 and conducted by Evaluator Alexander Pitz

COMPLAINT CONTROL NUMBER: 31-AS-20200903164427

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):

1
2
3
4
5
6
7
8
9

Staff not treating resident with dignity.

INVESTIGATION FINDINGS:

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

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

During this investigation, LPA Smith conducted a virtual visit on 9/14/20 and interviewed the administrator; on 12/14/21 at 10:00am LPA conducted a visit to the facility and interviewed the complainant telephonically, three staff members and 11 residents.

Allegation #1, that "staff not treating resident with dignity" has been unsubstantiated based on the interviews conducted. The complainant was not able to provide any additional corroborating evidence in support of the allegation, and 10/11 of the residents interviewed stated that staff treat them with dignity.

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

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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