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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 05/16/2022
Date Signed: 05/16/2022 06:01:05 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
05/09/2022 and conducted by Evaluator Joscelyn Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20220509132935
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: 106DATE:
05/16/2022
UNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Aristotle Vergara TIME COMPLETED:
06:10 PM
ALLEGATION(S):
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Staff not providing adequate care to resident in care.
Staff do not respond to resident's call light in a timely manner.
Resident left in soiled diapers for an extended amount of time.
INVESTIGATION FINDINGS:
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On 05/16/22 Licensing Program Analyst (LPA) Joscelyn Martinez arrived at the facility to conduct an announced complaint visit. LPA Martinez met with Administrator Aristotle Vergara and the purpose of the visit was explained.

Staff not providing adequate care to resident in care.
To investigate this allegation, LPA Martinez interviewed ten (10) residents and three (3) caregivers. Interviews by residents revealed that seven (7) out of ten (10) residents are not being provide adequate care. Residents stated they is not enough staff and are left waiting for a long period of time to be assisted. Residents stated they are left waiting for a long period of time to be changed, fed, or when requesting help out of the bed. Interviews with two (2) out of three (3) caregivers revealed that they require more caregivers to meet the resident’s needs. During today’s visit LPA only observed five (5) caregivers in the facility. LPA also observed administrative staff assisted residents that required assistance Based on the interviews obtained, this allegation is deemed Substantiated at this time.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Joscelyn MartinezTELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2022
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 5
Control Number 31-AS-20220509132935
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: 05/16/2022
NARRATIVE
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Staff do not respond to resident's call light in a timely manner

To investigate this allegation, LPA Martinez interviewed ten (10) residents and four (4) staff members. Eight (8) out of the ten (10) residents are bedbound or non-ambulatory. Seven (7) out of ten (10) residents stated when they pull the cord for assistance it can take a while for a staff member to come to the room. Residents stated on average it can be 20 minutes two (2) hours before a staff goes to the room to assist. Two (2) out four (4) staff stated caregivers need to be responding within five minutes of receiving the radio call that a resident is requesting assistance. Based on interviews obtained, this allegation is deemed Substantiated at this time.

Resident left in soiled diapers for an extended amount of time

To investigate this allegation, LPA Martinez interviewed ten (10) residents. Of these ten (10) residents, eight (8) require incontinence care. Interviews revealed that seven (7) out of ten (10) residents have been left in diapers for an extended amount of time. All these seven (7) residents stated they have waited on average a couple of hours to be changed due to insufficient staffing. Two (2) out of 10 residents who do not require incontinence care stated they are aware that residents are not being changed in an appropriate amount of time. One (1) resident out of ten (10) stated staff will change them in an appropriate amount of time. Based on the interviews obtained, this allegation is deemed Substantiated at this time.

Deficiencies on 809-D. 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: 05/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 31-AS-20220509132935
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: 05/16/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/18/2022
Section Cited
CCR
87464(f)(4)
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87464(f)(4) Basic Services. Personal assistance and care as needed by the resident...with those activities of daily living such as dressing, eating, bathing...
This requirement is not met as evidenced by:
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The Administrator has agreed to the following:
1. Submit a comprehensive plan on how facilty staff will respond to pull cords in a timely manner by POC due date.
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Based on interviews, staff failed to respond to pull cords in a timely manner.
This poses an immediate healthy and safety risk to residents in care.
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Type A
05/18/2022
Section Cited
CCR
87625(b)(3)
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87625(b)(3) Managed Incontinence Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This requirement is not met as evidenced by:

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The Administrator has agreed to the following:
1. Submit a comprehensive plan on how facilty staff will ensure residents are changed when soiled and in a timely manner.
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Based on interviews, residents were left in soild diapers for an extended period of time and will have to wait when requsted assistance for changing. This poses an immediate healthy and safety risk to residents in care.
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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: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Joscelyn MartinezTELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 31-AS-20220509132935
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: 05/16/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/20/2022
Section Cited
CCR
87468.2(a)(4)
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87468. (a)(4) Additional Personal Rights of Residents in Privately Operated Facilities to care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement is not met as evidenced by:
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The Administrator has agreed to the following:
1. Submit a comprehensive plan on how facilty staff will ensure residents are obtaining adequate care in a timely manner.
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Residents are not receiving adequate care and are left waiting a long period to receive care by staff. This poses a potential healthy and safety risk to residents in care.
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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: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Joscelyn MartinezTELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5