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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 08/16/2022
Date Signed: 08/16/2022 02:22:20 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
04/15/2022 and conducted by Evaluator Joscelyn Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20220415130503
FACILITY NAME:CEDARS ASSISTED LIVING, THEFACILITY NUMBER:
197608267
ADMINISTRATOR:ARISTOTLE B. VERGARAFACILITY TYPE:
740
ADDRESS:17300 ROSCOE BLVD.TELEPHONE:
(818) 344-2042
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY:175CENSUS: 108DATE:
08/16/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Aristotle VergaraTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Facility not meeting resident's medical needs.
Resident's sheets are soiled.
INVESTIGATION FINDINGS:
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On 09/16/22 Licensing Program Analyst (LPA) Joscelyn Martinez arrived at the facility to conduct an unannounced subsequent complaint investigation. Upon arrival LPA met with Administrator Aristotle Vergara and the purpose of the visit was explained.

Allegation #1 Facility not meeting resident's medical needs.
It is alleged that the facility is not providing transportation to meet resident’s medical needs. To investigate this allegation, LPA conducted interviews with eleven residents. According to interviews, ten (10) out of eleven (11) residents stated they are aware that the facility provides transportation and are aware of the procedure of request transportation. One resident, (R1) stated they were not aware the facility provided transportation. According to R1’s signed Residence and Care Agreement, under “Section I. Services subsection 7” states, “We will provide scheduled transportation to local medical and dental facilities at no extra charge in accordance with the transportation policy described in the Resident Handbook.”. Interview with Administrator determine the Residence and Care Agreement is explained to new residents before residents sign the agreement. Based on interviews and document review this allegation is deemed Unsubstantiated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Joscelyn MartinezTELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 31-AS-20220415130503
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: 08/16/2022
NARRATIVE
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Allegation #2 Resident's sheets are soiled.

It is alleged that a resident’s sheets are soiled and not changed in a timely manner which caused a skin breakage. To investigate this allegation, LPA interviewed eleven (11) residents. Eleven (11) out of eleven (11) residents stated if their sheets are soiled, the sheets are changed and put in the laundry. All residents stated they have not obtained any skin breakage or wound due to sheets being soiled and not changed in a timely manner. Based on interviews, this allegation is deemed Unsubstantiated.

No deficienes issued. Exit interview conducted. Report signed and delivered. Appeal rights delivered.

SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Joscelyn MartinezTELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2