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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 02:21:20 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
09/16/2021 and conducted by Evaluator Joscelyn Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20210916134720
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 Vergara TIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Facility failed to provide adequate food service.
Facility failed to meet resident's needs.
Facility staff can't communicate with resident due to language barrier
INVESTIGATION FINDINGS:
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On 08/16/22 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 failed to provide adequate food service
It is alleged that the facility is not providing adequate food service to the resident in care that has a preferred diet. To investigate this complaint, LPA interviewed eleven (11) residents. Nine (9) out of eleven (11) residents stated the food and food service is okay at the facility. Interview with one (1) out of eleven (11) residents determined that the facility does not have a variety of vegetarian options. Interview with S1 determined that the facility is incorporating more vegetarian options for residents, but do have some vegetarian options. According to document review, residents have the options of choosing a meal on the alternative menu and are able to modify their food request ahead of time. Based on interviews and documentation 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-20210916134720
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 Facility failed to meet resident's needs.

It is alleged that the resident feels the facility is not meeting their needs. To investigate this allegation, LPA interviewed eleven (11) residents. Nine (9) out of eleven (11) residents stated their basic needs are being met by the facility which include assistance with daily living activities. Based on interviews, this allegation is deemed Unsubstantiated.

Allegation# 3 Facility staff can't communicate with resident due to language barrier.

It is alleged that a resident is cannot communicate with staff due to language barrier. To investigate this allegation LPA interviewed eleven (11) residents. Nine (9) out of eleven (11) residents stated they do not have any issues communicating with staff. Interviews with staff determine that all staff speak basic English and are able to understand and communicate resident's needs. Based on interviews, this allegation is deemed Unsubstantiated.

No deficiencies cited. Appeal rights delivered. Exit interview conducted and report signed and 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