197608267-9-14-2022-31-AS-RRAZ-CLENUP-20221122094641

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 09/14/2022
Date Signed: 09/14/2022 01:35:27 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, 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:	09/14/2022
		UNANNOUNCED	TIME BEGAN:	12:40 PM
MET WITH:	Aristotle Vergara		TIME COMPLETED:	01:50 PM

ALLEGATION(S):

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Facilities food service is inadequate
Staff do not treat resident with dignity.

INVESTIGATION FINDINGS:

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On 09/14/22 Licensing Program Analyst (LPA) Joscelyn Martinez arrived at the facility to conducted a subsequent complaint investigation. Upon arrival LPA met with administrator Aris Vergara and the purpose of the visit was explained.

Allegation: Facilities food service is inadequate

It is alleged that facility food service is inadequate to residents who have food delivered to their room. To investigate this allegation LPA interviewed elven (11) residents at the facility of which give (5) require daily room tray delivery. Interviews revealed residents that require room tray delivery are left waiting a long period of time to receive their food or to be fed by staff. Interviews revaled residents wait up to two hours after dining room opens for their plates to be delivered. Interviews with staff determined that staff first serve residents in the dining room and then plates are delivered to residents in room. Based on interviews, this allegation is deemed Substantiated.

Substantiated

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: 09/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022

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-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: 09/14/2022

NARRATIVE

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Allegation: Staff do not treat resident with dignity.

It is alleged that staff are not treating resident with dignity. To investigate this allegation LPA interviewed ten (10) residents. Six (6) out of ten (10) residents stated they are not treated with dignity by the staff providing care to them. Interviews with staff and administrator revealed they have not heard any residents state they are not being treated with dignity. Based on interviews obtained by the residents, this allegation is deemed Substantiated.

Deficiencies issued on LIC 9009-D. 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: 09/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022

LIC9099 (FAS) - (06/04)

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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: 09/14/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/21/2022 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	8741 Personnel Requirements – General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Administrator will develop a plan on how residents will receive their room meal tray delivered once the dining room starts serving food. Administrator will submit plan to LPA via email by 09/21/22.
	8 9 10 11 12 13 14	Based on interviews, residents are left waiting a long period of times to receive food trays delivered to their rooms, which poses a potential healthy and safety risk to residents in care.	8 9 10 11 12 13 14
Type B 09/28/2022 Section Cited CCR 87468.1(a)(1)	1 2 3 4 5 6 7	87468.1(a)(1) 87468.1 Personal Rights of Residents in All Facilities. To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Administrator is to conduct training with all staff on personal rights for residents in care. Administrator is to email proof of training to LPA via email no later than 09/28/22.
	8 9 10 11 12 13 14	Residents in care stated they do not feel that staff are treating them with dignity, which poses a potential healthy and safety risk to residents in care.	8 9 10 11 12 13 14

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 Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Joscelyn Martinez	TELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022

LIC9099 (FAS) - (06/04)

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