197608267-4-16-2022-31-AS-NGID-CEZUFV-20220602153319

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 04/16/2022
Date Signed: 04/16/2022 01:18:42 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
10/20/2021 and conducted by Evaluator Joscelyn Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20211020122325

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

ALLEGATION(S):

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Resident was left in soiled diaper for extended period of time
Staff does not allow residents to receive visitations

INVESTIGATION FINDINGS:

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On 04/16/22 at 10:30 a.m Licensing Program Analyst (LPA) Joscelyn Martinez arrived at the facility to conduct a subsequent complaint visit. LPA met with Lourdes Kazdan and the purpose of the visit was explained.

Allegation: Resident was left in soiled diaper for extended period of time.

Regarding this allegation it is alleged that R2 was left in a soiled diaper for an extended period of time. LPA conducted a previous visit on 10/25/2021 where residents, including R2 and staff were interviewed. LPA also obtained R2’s physician reports and resident appraisal. Based on this information obtained through interviews and record reviews this allegation is deemed Unsubstantiated at this time.

Continue on 9099C

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: 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-20211020122325

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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Allegation: Staff does not allow residents to receive visitations

Regarding allegation it is alleged that residents were not allowed to receive visitors. LPA conducted a previous visit on 10/25/2021 where residents and staff were interviewed. Based on these interviews, residents were allowed to have visitors through appointments. Interviews revealed that R1 had a guest who was violating house rules and causing a disturbance. After multiple incidents this guest was not allowed to visit inside the facility but could visit resident outside of the facility. Based on this information this allegation is deemed Unsubstantiated.

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: 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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