197608267-3-16-2022-31-AS-MVAO-CD9V9V-20220407161458

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 03/16/2022
Date Signed: 03/16/2022 01:09:05 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
10/14/2020 and conducted by Evaluator Rosaura Valenzuela

COMPLAINT CONTROL NUMBER: 31-AS-20201014085154

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:	03/16/2022
		UNANNOUNCED	TIME BEGAN:	12:04 PM
MET WITH:	Lourdes Kazdan, Manager		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Facility staff are mismanaging resident's medication

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rosaura Valenzuela conducted a subsequent visit to deliver the finding for the above noted allegation. LPA met with Lourdes Kadzan, Manager and explained the purpose of the visit.

It was reported that facility staff are mismanaging resident's medication. To investigate this allegation, LPA Valenzuela on 10/22/2020 at 8:47am spoke to Resident # 1's (R1's) case manager who indicated that R1 had not been receiving their medication due to insurance issues. There was a misunderstanding that happened between R1 and their insurance. Case manager was able to resolve the problem. On 10/22/2020 staff and resident interviews were initiated between 4:10pm and 5:12pm. Staff interviews revealed that medication is stored in the medication room in the form of a bubble pack. When a resident can not afford to pay then the facility will cover the costs until the situation is resolved. In this case, the facility reached out to R1's case manager and they were able to resolve the problem. Between 4:30pm and 5:10pm, nine residents were interviewed. Interviews revealed that they have not experienced any issues with the dispensing or administration
Continue on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: (818) 421-5360
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2022

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-20201014085154

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: 03/16/2022

NARRATIVE

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of their medications. On 10/23/2020, at 10:30am, LPA reviewed facility records. LPA looked at the Medical Administration Records (M.A.R.) of approximately a dozen residents for the past two months. Records did not reveal any discrepancies.

Based on observation, interviews, and records review there is not sufficient information to support this allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

Exit interview conducted and a copy of the report was issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: (818) 421-5360
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2022

LIC9099 (FAS) - (06/04)

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