197608267-10-28-2021-31-AS-MVAO-CD3TRV-20220401145810

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 10/28/2021
Date Signed: 10/28/2021 03:27:07 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
10/26/2021 and conducted by Evaluator Joscelyn Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20211026121025

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: 104	DATE:	10/28/2021
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Administrator Aris Vergara		TIME COMPLETED:	03:40 PM

ALLEGATION(S):

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Staff do not answer facility phone.

INVESTIGATION FINDINGS:

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LPA Martinez conducted an announced complaint visit to the facility. LPA met Wellness Care Coordinator and then with Administrator. The purpose of this visit was explained.
Allegation: Staff do not answer facility phone.
It is alleged that staff does not answer the facility phone during the evening shift and NOC shift hours, when the resident #1 (R1) calls for assistance.
To investigate the allegation, between 11:30 am and 2:00pm LPA Martinez conducted interviews with ten (10) out of one hundred and four (104) residents. Interviews revealed that residents are using the pull cord(s) during an emergency. At times, during emergency they may use the phone to call the reception desk to get a staff to assist them. At 2:15 PM LPA spoke with the two (02) facility staff working in the evening and nighttime. Staff explained the procedures for evening and nighttime for when a staff receives a call from a resident requesting assistance.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Joscelyn Martinez	TELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021

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-20211026121025

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: 10/28/2021

NARRATIVE

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Facility calls are transferred to the staff in charge during the shift and then get delegated to other staff to respond physically. The staff need to prioritize emergency call first and then they can assist the non-emergency calls. The resident #1 (R1) is one of the residents that is calling for non-emergency reasons. Therefore, the staff is attending R1 after assisting the residents with an emergency needs.
During this visit at 12:18 LPA tested the pull cord(s) and they appeared to be operable.
Based on interviews, inspection and observation, there is no sufficient information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.
Exit interview was conducted and a copy of report was issued

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Joscelyn Martinez	TELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021

LIC9099 (FAS) - (06/04)

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