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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608267
Report Date: 12/21/2022
Date Signed: 12/21/2022 03:32:22 PM


Document Has Been Signed on 12/21/2022 03:32 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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, THEFACILITY NUMBER:
197608267
ADMINISTRATOR:ARISTOTLE B. VERGARAFACILITY TYPE:
740
ADDRESS:17300 ROSCOE BLVD.TELEPHONE:
(818) 344-2042
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY:175CENSUS: 125DATE:
12/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 AM
MET WITH:Aristotle B. Vergara TIME COMPLETED:
03:40 AM
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On 12/21/22, Licensing Program Analysts (LPA) Melissa Ruiz and Joscelyn Martinez arrived at the facility to conduct an unannounced annual inspection. Upon arrival, LPA was greeted by a staff member. LPA observed covid-19 signage, hand sanitizer, and covid-19 signage posted outside and throughout the facility’s main entrance. LPAs signed in using the visitor’s log and LPAs observed all staff to be wearing masks. LPAs later met with the Administrator and the purpose of the visit was explained.

LPA initiated a physical plant tour. Facility is a Residential Care Facility for the Elderly which is Facility licensed for 175 residents’ non-ambulatory residents. Facility has been approved for a hospice waiver for seventy-five (75) residents. LPA was able to tour the facility and did not observe any immediate health and safety concerns. Sufficient PPE supplies were observed. The latest fire safety inspection was conducted in August 2022. Bedrooms are appropriately furnished and have appropriate lighting. Bathrooms have soap, paper towels and hand washing signs were observed. Extra towels and linens were readily available. There are various covered shaded area in the back yard and there are no bodies of water.

No deficiencies issued during today’s visit. Report was signed and delivered by Administrator and an exit interview was conducted.
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Melissa RuizTELEPHONE: (818) 401-7980
LICENSING EVALUATOR SIGNATURE:
DATE: 12/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/21/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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