197608267-2-10-2022-31-AS-EMIR-CCXPL3-20220328112401

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 02/10/2022
Date Signed: 02/10/2022 03:00:08 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
09/30/2020 and conducted by Evaluator Alexander Pitz

COMPLAINT CONTROL NUMBER: 31-AS-20200930103234

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: 103	DATE:	02/10/2022
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Aris Vergara		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Facility has rodents

INVESTIGATION FINDINGS:

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

During this investigation LPA conducted a virtual visit on 10/09/2020 at 1:30pm to interview staff and request facility pest control records; conducted a visit on 2/10/22 at 10:15am and interviewed the facility administrator, 10 residents, and reviewed additional pest control records.
Allegation #1, that "Facility has rodents" has been substantiated based on the records reviewed and interviews conducted. The most recent inspection report, conducted by First Quality Pest Control on 1/14/22, indicates that "notice of rodents droppings in kitchen floor. set some rodent traps...rodent droppings need to be sanitized and remove. Need to follow up once a week. check traps." 5/10 residents interviewed on 2/10/22 at 2:00pm stated they had seen rodents on the property.
Report reviewed, signed and delivered. Exit interview conducted, deficiency cited on 9099D page.

Substantiated

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: 02/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2022

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-20200930103234

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/10/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/07/2022 Section Cited CCR 87464(f)(2)	1 2 3 4 5 6 7	(2) Safe and healthful living accommodations and services, as specified in Section 87307, Personal Accommodations and Service This requirement is not met as evidenced by:	1 2 3 4 5 6 7	All staff members will be provided with training on pest prevention measures and rodent dropping sanitization procedures. A log will be created to document weekly checks of rodent traps from now through the POC due date and submitted to LPA along with training records.
	8 9 10 11 12 13 14	Based on records reviewed, the faciity did not ensure that it was kept free from rodents which poses a potential risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Alexander Pitz	TELEPHONE: (805) 450-1627
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2022

LIC9099 (FAS) - (06/04)

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