197608267-5-26-2022-31-AS-NGID-CEZUFU-20220602153319

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 05/26/2022
Date Signed: 05/26/2022 02:12:14 PM

Substantiated

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

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: 108	DATE:	05/26/2022
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Aristotle Vergara		TIME COMPLETED:	02:20 PM

ALLEGATION(S):

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Resident was left in soiled diaper for extended period of time

INVESTIGATION FINDINGS:

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On 05/26/22 Licensing Program Analyst (LPA) Joscelyn Martinez arrived at the facility to conduct a subsequent complaint visit. LPA met with Administrator Aristotle Vergara and the purpose of the visit was explained. This is an amended report for complaint # 31-AS-20211020122325 issued on 04/16/22.

On 05/16/22 LPA interviewed five additional residents that require incontinence care. All five residents stated they have been left in soiled diaper for an extended period of time on more than one occasion. Based on the additional information received during the visit, this allegation is deemed Substantiated at this time.

Deficiency was issued on 05/16/22 with complaint # 31-AS-20220509132935.

Exit interview conducted. Report signed and delivered.

Substantiated

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: 05/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2022

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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