197608267-9-9-2022-31-AS-NGID-CJNRU7-20220927131927

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 09/09/2022
Date Signed: 09/09/2022 12:16:58 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
09/07/2022 and conducted by Evaluator Wendell Smith

COMPLAINT CONTROL NUMBER: 31-AS-20220907144131

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: 114	DATE:	09/09/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Kandice Williams		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff members not allowing resident to speak with medical provider.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced complaint visit to investigate the allegation above. LPA met with facility staff and explained the reason for this visit.
Physical plan tour was done from 9:40-10am and no immediate health and safe issues were noted.
It is alleged that a medical provider has called the facility to speak with resident #1 (R1) on several occasions and that facility staff has refused to let them speak with R1. During today's visit LPA conducted interviews with R1 and facility staff from 10-11:30am. Information from interviews reveal that the medical provider called on three different occasions on 9/7/22 and facility staff did not get R1 on the telephone. Facility staff stated it was procedure for them to speak with the wellness director before speaking with R1. During the interview with R1 it was found that R1 was not aware that their medical provider was trying to reach them. Based on the information obtained through interviews this allegation is deemed Substantiated. Facility staff failed to let R1 speak to their medical provider. Deficiency cited on LIC 9099 D. Appeal Rights explained. Copy of report issued. Exit Interview conducted.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Wendell Smith	TELEPHONE: (818) 738-4525
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2022

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-20220907144131

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/09/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/13/2022 Section Cited CCR 87468.1(a)(16)	1 2 3 4 5 6 7	Personal Rights of Residents in All Facilities:Residents in all residential care facilities for the elderly shall have all of the following personal rights-To receive or reject medical care or other services. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Administrator shall have an in-service with staff regarding protocol when medical providers call to speak with residents and how to proceed to get the residents on the phone with their medical provider. Copy of in-service sign in sheet to be sent to LPA by poc due date.
	8 9 10 11 12 13 14	Based on interviews conducted facility failed to let R1 speak to their medical provider when they called on three different occasions. This posed a potential health and safety risk to R1.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Wendell Smith	TELEPHONE: (818) 738-4525
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 2