197608267-5-2-2022-31-AS-NGID-CEPRZY-20220523132841

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 05/02/2022
Date Signed: 05/02/2022 04:27:32 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
10/12/2021 and conducted by Evaluator Joscelyn Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20211012153541

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: 107	DATE:	05/02/2022
		UNANNOUNCED	TIME BEGAN:	11:10 AM
MET WITH:	Aris Vergara		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Facility staff locked residents out of their rooms
Facility staff are not properly supervising residents

INVESTIGATION FINDINGS:

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On 05/02/22 Licensing Program Analyst (LPA) Joscelyn Martinez conducted an unannounced Subsequent Complaint visit. LPA met with Administrator Aris Vergara and the purpose of the visit was explained.

On 04/21/22 LPA Martinez conducted a full walk through with staff (S2) inside both memory care units. LPA check all doors located inside one unit and observed doors to be unlocked. LPA observed some doors to be locked inside the second memory care unit. When LPA asked staff to open the door LPA observed no residents inside the rooms. LPA asked why these doors were locked and S2 stated caregivers lock the door when the resident steps out to go to the dining area. This is done to safeguard resident’s property and prevent any theft. Once the resident requests to go back inside their room the door is then unlocked. Based on observation and interviews this allegation is deemed Unsubstantiated at this time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Joscelyn Martinez	TELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2022

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-20211012153541

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: 05/02/2022

NARRATIVE

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To investigate this allegation LPA Martinez conducted interviews with staff and residents. Interviews revealed residents in memory care will typically wander into another resident’s room if the door is wide opened. When staff observe this happening, they redirect the resident to a shared area or to their room. Based on interviews and observation this allegation is deemed Unsubstantiated at this time

No deficiencies cited at this time. Exit interview conducted. Report signed and delivered.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Joscelyn Martinez	TELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2022

LIC9099 (FAS) - (06/04)

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