197608267-1-19-2023-31-AS-NGID-CNGT58-20230127132508

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 01/19/2023
Date Signed: 01/19/2023 03:19:53 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
01/09/2023 and conducted by Evaluator Joscelyn Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20230109115238

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: 121	DATE:	01/19/2023
		UNANNOUNCED	TIME BEGAN:	02:20 PM
MET WITH:	Aris Vergara		TIME COMPLETED:	03:20 PM

ALLEGATION(S):

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Staff member is physically abusing resident in care.

INVESTIGATION FINDINGS:

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On 01/19/23 Licensing Program Analyst (LPA) Joscelyn Martinez arrived at the facility to conducted an unannounced subsequent complaint visit. Upon arrival LPA met with administrator and the purpose of the visit was explained.

Allegation: Staff member is physically abusing resident in care.
It is alleged that R1 is being physically abused by staff while in care. LPA conducted an interview with R1 regarding the allegation. Interview revealed that R1 is being abuse by every staff at the facility but was unable to provide details to the allegations. Interviews with two administrative staff revealed that R1 called the Los Angeles Police Department on 01/08/22 for a welfare check but the officers found no evidence of a crime or elder abuse. Interviews two caregivers that provide care to R1 stated they have not witness nor have they physically abused the resident . Based on the information obtained, there was insufficient evidence to confirm the allegation occurred. This allegation is deemed Unsubstantiated at this time.

Exit interview conducted. Report signed and delivered.

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: 01/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2023

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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