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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608267
Report Date: 10/28/2020
Date Signed: 10/28/2020 03:26:32 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME:CEDARS ASSISTED LIVING, THEFACILITY NUMBER:
197608267
ADMINISTRATOR:ARISTOTLE B. VERGARAFACILITY TYPE:
740
ADDRESS:17300 ROSCOE BLVD.TELEPHONE:
(818) 344-2042
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY:175CENSUS: 120DATE:
10/28/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Aris VergaraTIME COMPLETED:
02:55 PM
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Licensing Program Analyst (LPA) Ashley Smith initiated a Case Management - Incident visit. The purpose of this visit is to conclude an investigation initiated by LPA Perera during a Case Management – Incident visit conducted on 06/19/2020. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, todays visit was conducted virtually via FaceTime with Aris Vergara. Entrance interview conducted.

On 06/17/2020, the department received an incident report reflecting that on 05/29/2020, it was reported that Resident #1 (R1) requested staff #1 (S1) to perform an inappropriate sexual act and S1 obliged to R1’s request. Per the report submitted, the incident was witnessed by staff #2 (S2). Investigator Herman Sandhu from Community Care Licensing Division’s Investigation’s Branch (IB) conducted this investigation. During the initial visit conducted on 06/19/2020, LPA Perera conducted an interview with the facility administrator at 12:46pm to obtain additional information and request pertinent documentation relating to the incident. In addition, the LPA also conducted a brief virtual tour of the physical plant at 11:30am. During the course of the investigation, Investigator Sandhu conducted interviews with facility staff on 06/15/2020 at 9:45am, 06/25/2020 at 11:55am and on 08/31/2020 at 11:33am. An interview was also conducted with R1 on 08/20/2020 at 11:25am. Furthermore, Investigator Sandhu obtained a police report relating to the incident from Los Angeles Police Department (West Valley station) on 06/25/2020 at 12:30pm.

Based on all information gathered, the Department does not have sufficient evidence to determine that S1 performed an inappropriate sexual act on R1 per R1’s request. In addition, per the police report, R1 denied any abuse and the case was rejected by the District Attorney’s office.

Exit interview conducted. No citations issued. A copy of the report was sent via email for signature.
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley SmithTELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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