197608267-11-18-2021-31-AS-NMAN-CHUKPC-20220901080428

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 11/18/2021
Date Signed: 11/18/2021 02:41:40 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
11/16/2021 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20211116121503

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:	11/18/2021
		UNANNOUNCED	TIME BEGAN:	08:42 AM
MET WITH:	Aristotle Vergara - Administrator		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Resident is being abused while in care

Resident is being forced to stay at the facility and not allowed to go anywhere.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced initial complaint visit at this facility to investigate the above allegations. LPA met with administrator Aristotle Vergara and explained the reason for the visit.

LPA conducted physical plant tour at 9:15 AM, requested copies of facility documents relevant to the investigation at 10:00 AM and conducted interview with staff, administrator and resident between 10:30 AM to 12:30 PM. Regarding the allegation that resident is being abused while in care, it was alleged that Resident #1 (R1) has been transferred from one assisted living facility to another but always from the same owner. LPA record review at 12:30 PM revealed that R1 was admitted at this facility on 07/14/21 from a Rehabilitation Center in West hills where R1 was admitted on 05/12/21. Further review also revealed that R1 was discharged from a six (6) bed Residential Care for the Elderly facility in Granada hills where R1 stayed for almost two (2) years, prior to R1's Rehabilitation Center admission.
(continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021

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-20211116121503

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: 11/18/2021

NARRATIVE

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(continued from LIC 9099)

These last three (3) facilities that R1 recently stayed are not associated with each other nor owned by only one (1) company. LPA's interview with R1 today at 10:50 AM, also revealed that R1 was not being abused nor anyone is abusing R1 at the facility.

Regarding the allegation that resident is being forced to stay at the facility and not allowed to go anywhere, it was alleged that R1 does not have a choice of where he wants to go but being forced to be at the Perpetrator's facility. LPA's interview with R1 today at 10:50 AM revealed that no one was forcing R1 to stay at the facility. LPA's interview with staff also revealed that R1 has a case manager who placed R1 at the facility and it is up to R1 and R1's case manager if R1 would like to move to any other facility. LPA's interview with R1's case manager also revealed that R1 would like to move to an Skilled Nursing Facility (SNF) on a permanent basis but may not be eligible as R1 may not have the required diagnosis.

Based on the information gathered during this visit, the allegations are deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021

LIC9099 (FAS) - (06/04)

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