197608267-5-6-2022-31-AS-NGID-CELSM5-20220520135923

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 05/06/2022
Date Signed: 05/06/2022 12:02:59 PM

Unsubstantiated

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
03/01/2022 and conducted by Evaluator Angela Panushkina

COMPLAINT CONTROL NUMBER: 31-AS-20220301125656

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: 110	DATE:	05/06/2022
		UNANNOUNCED	TIME BEGAN:	11:10 AM
MET WITH:	Aris Vergara, Administrator		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Staff is inappropriately touching a resident while in care
Staff mishandles a resident while in care

INVESTIGATION FINDINGS:

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At 11:10am Licensing Program Analyst (LPA) Angela Panushkina conducted an unannounced subsequent complaint visit to deliver the finings for the above stated allegations. LPA met with the Administrator, Aristotle Vergara, and explained the reason for the visit.

LPA conducted a physical plant walk through, at approximately 11:30am, to ensure that the facility is in compliance with rules and regulations under California Code of Regulations, Title 22, Division 6. LPA did not observe any immediate health and safety issues during the visit.

An initial 10-day complaint visit conducted on 03/02/22. During that visit LPA Panushkina conducted interviews (between 1:00pm – 2:45pm) with the Administrator Resident Care Director and four (4) out of six (6) staff and reviewed facility records. File records consisted, but were not limited to review of the Physician’s Report, Resident Care Plans, Relevant Logs, etc.
Continue on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2022

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-20220301125656

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: 05/06/2022

NARRATIVE

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In addition, LPA requested Medical Records from Kaiser Permanente on 03/09/22 and received the results on 03/09/22.

Allegations: 1. Staff is inappropriately touching a resident while in care
2. Staff mishandles a resident while in care
To investigate the above two (2) allegations, LPA interviewed the Administrator, four (4) out of six (6) staff members, Resident Care Director (RCD), Wellness Coordinator, resident #1 and reviewed Medical Records. Interview with the Administrator indicated that all staff members are trained on how to approach and change incontinent residents and that they always treat residents with dignity and respect. Moreover, the interview with the Administrator indicated that if a staff member is unable to change a resident, they always ask to see if another staff member can assist. Administrator stated: "It is always our residents preference." Interviews with four (4) out of six (6) staff indicated that they always communicate with residents before approaching them and if the resident is combative and doesn't want to be changed they walk away and try to come back later. If during the second attempt the resident continues being combative, the staff calls another staff member for help. Four (4) out of six (6) staff members indicated that once the resident recognizes familiar faces they cooperate better. Interview with the Resident Care Director (RCD) indicated that if the resident doesn't want to be changed, staff will ask another staff member for help. And, if the staff member still can't handle the situation, they will call the MedTech and they will check the resident's diagnoses and the medications that were taken of skipped. Finally, they will contact the family and a Case Manager. RCD stated: "Usually, second face has a luck." Interview with Wellness Coordinator revealed that R1 recognized most of the staff members and was very compliant. LPA attempted to interview R1, but was unable to, due to R1's medical condition.

In addition, Medical Records received on 03/09/22 from Kaiser Permanente, regarding R1, indicated negative results to any kind of abuse from the lab test conducted on 02/27/22 and 03/01/22. Based on information obtained through interviews and record reviews this allegation is deemed Unsubstantiated at this time.

Exit interview conducted and copy of the report given to the Administrator.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2022

LIC9099 (FAS) - (06/04)

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