197608267-10-20-2022-31-AS-RRAZ-CKQQSG-20221031122533

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 10/20/2022
Date Signed: 10/20/2022 03:07:51 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
10/12/2022 and conducted by Evaluator Joscelyn Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20221012141842

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: 117	DATE:	10/20/2022
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Aris Vergara		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff are pulling a resident's hair while in care
Staff are pushing a resident out of their wheelchair while in care
Staff are dragging a resident on the floor
Resident's personal belongings are not safeguarded while in care
Resident's incontinence needs are not being met
Resident is not being fed while in care
Resident is not being provided physical therapy while in care

INVESTIGATION FINDINGS:

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On 10/20/22 Licensing Program Analysts (LPAs) Joscelyn Martinez and Melissa Ruiz conducted an unannounced complaint investigation. Upon arrival LPA met with staff and later met with administrator Aristotle Vergara. The purpose of the visit was explained.

Allegation 1: Staff are pulling a resident's hair while in care
Allegation 2: Staff are pushing a resident out of their wheelchair while in care
Allegation 3: Staff are dragging a resident on the floor

It is alleged that staff are pulling residents hair, pushing resident out of their wheelchair, and are dragging resident on the floor. To investigate these allegations LPAs conducted interviews with R1, administrator, and two direct staff for R1. Interviews with R1 revealed being physically and mentally abuse, but was unable to provide any details on the alleged abuse. R1 gave a description of the staff responsible for their care but could not provide any names of the staff.

Unsubstantiated

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: 10/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022

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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Control Number 31-AS-20221012141842

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: 10/20/2022

NARRATIVE

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LPAs requested and reviewed facility's Personnel Report (LIC 500) and interviewed staff assigned to R1's care. Interviews with two staff revealed they have never pulled R1's hair, pushed R1 out of their wheelchair, nor drag R1 on the floor. Both staff stated they have never verbally or physically abused R1. Both staff indicated R1 has lots of bad days that include R1 cussing, yelling, declining services such as showers, eating, and incontinence care. When R1 is having a good day, staff are able to provide all of the services without any issues from R1. Interview with administrator revealed they have not witness nor heard any complains from residents in which staff are pulling residents hair, pushing resident out of their wheelchair, or dragging resident on the floor. Based on interviews, these allegations is deemed Unsubstantiated.

Allegation 4: Resident's personal belongings are not safeguarded while in care
It is alleged that resident’s (R1) clothing is being stolen during laundry service. To investigate this allegation LPA interviewed R1 and administrator. Interview with R1 revealed they have no issues with their clothes being stolen or missing. R1 stated once the laundry is completed staff will drop off R1’s clothing back inside their room in a black bag. Interview with administrator revealed if clothes are reported missing by a resident, facility staff will search for the missing items and return the items to the resident once found. Based on interviews, this allegation is deemed Unsubstantiated.

Allegation 5: Resident's incontinence needs are not being met.

To investigate this allegation, LPAs conducted interviews with the Administrator, one resident, and two staff. The Administrator stated they are not aware of any issues regarding incontinence needs not being met and states that staff often deal with residents declining to be changed at that given moment. An interview with two staff (S1 & S2) revealed that R1 declines to be changed constantly. They both stated that R1 does not like to have their diaper changed. Lastly, both staff state that during their 8-hour shift, they attempt to change R1 between 3-4 times. LPAs interviewed R1, to which R1 stated that they only get changed twice a day, but if they have a bowel movement, staff will come and change them. Based on interviews conducted, there is insufficient evidence to prove “resident’s incontinence needs are not being met” therefore, this allegation is deemed Unsubstantiated at this time.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Joscelyn Martinez	TELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 31-AS-20221012141842

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: 10/20/2022

NARRATIVE

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Allegation 6: Resident is not being fed while in care.

To investigate this allegation, LPAs conducted interviews with R1, the Administrator, and two staff. Additionally, LPAs collected a weekly menu and observed residents eating in the dining area. The Administrator stated that to his knowledge, there has been no complaints or issues regarding residents not being fed. Administrator stated that if residents want to eat at different times or have food brought to their rooms, it is accommodated. An interview with R1 revealed that if they want food, they go to the dining area where food is provided. However, R1 stated that they do not like to go to the dining area and would rather eat in their room. R1 stated they are not always fond of the food, but when they are hungry it is provided. S1 and S2 both stated that R1 often refuses to eat when meals are offered. In fact, S2 stated that R2 denied breakfast and lunch today. Based on interviews conducted, this allegation is deemed unsubstantiated at this time.

Allegation 7: Resident is not being provided physical therapy while in care.

To investigate this allegation, LPAs conducted interviews with R1 and the Administrator. An interview with the Administrator revealed that the facility does not provide physical therapy to any residents in care, nor have they told residents that they provide such service to them. The Administrator stated that if residents require physical therapy, it is coordinated with outside agencies. An interview with R1 revealed that R1 does not get physical therapy and is unsure if the facility provides physical therapy. R1 does not know if they are supposed to received physical therapy. LPAs conducted record review – such as physician reports and pre-appraisal of needs and services, none of which indicate that R1 requires physical therapy. Based on interviews conducted and record review, this allegation is deemed unsubstantiated at this time.

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

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Joscelyn Martinez	TELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022

LIC9099 (FAS) - (06/04)

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