197608267-4-16-2022-31-AS-MVAO-CEQSRJ-20220524140623

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 04/16/2022
Date Signed: 04/16/2022 05:40:51 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
09/28/2021 and conducted by Evaluator Wendell Smith

COMPLAINT CONTROL NUMBER: 31-AS-20210928124225

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: 108	DATE:	04/16/2022
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Lourdes Kazean		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff did not assist resident with incontinence care
Staff did not assist resident with obtaining medical care
Staff do not provide showers for resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced subsequent visit to finish investigation into the allegations above. LPA met with facility staff and explained the reason for this visit.

Staff did not assist resident with incontinence care
Regarding this allegation it is alleged that resident #1 (R1) was not being assisted with incontinent care. LPA conducted a previous visits on 9/29/21 and 10/25/21 where R1 was interviewed along with facility staff. LPA also obtained copies of R1's physician report and needs and service plan. Information from interviews revealed that there is not enough information to state that facility staff is not receiving assistance with Incontinence care, therefore this allegation is deemed Unsubstantiated at this time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Wendell Smith	TELEPHONE: (818) 738-4525
LICENSING EVALUATOR SIGNATURE:	DATE: 04/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2022

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-20210928124225

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: 04/16/2022

NARRATIVE

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Staff did not assist resident with obtaining medical care
It is alleged that R1 developed maggots in their leg and facility staff did not assist R1 with obtaining medical care. It is also alleged that facility staff do not assist resident # 2 (R2) with assistance with their needs. Regarding this allegation LPA conducted a previous visit on 10/25/21 where interviews were conducted with R1 and facility staff. Information from interviews reveal that R1 never had any issue with having maggots in their leg and this was never a problem. LPA interviewed R2 who stated that they receive assistance from staff regarding their needs and is happy with the care they are receiving at the facility. Based on the information obtained through interviews this allegation is deemed Unsubstantiated at this time.

Staff do not provide shower for resident
It is alleged that facility staff do not provide showers for R1. LPA conducted previous visits on 9/29/21 and 10/25/21 where interviews were conducted with residents and staff. Information from interviews reveal that R1 had a specific shower time but would often be out of the facility and wouldn't come back to the facility until later in the night and would miss their shower time. R1 would then want to get showered when they arrived back to the facility but it would sometimes be after 8pm. Based on the information obtained through interviews this allegation is deemed Unsubstantiated at this time.

Exit Interview conducted.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Wendell Smith	TELEPHONE: (818) 738-4525
LICENSING EVALUATOR SIGNATURE:	DATE: 04/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2022

LIC9099 (FAS) - (06/04)

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