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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 12/21/2022
Date Signed: 12/21/2022 03:40:19 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
03/08/2022 and conducted by Evaluator Joscelyn Martinez
COMPLAINT CONTROL NUMBER: 31-AS-20220308153826
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
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Aris Vergara TIME COMPLETED:
03:50 PM
ALLEGATION(S):
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Resident is not allowed visitors
Resident not allowed privacy
Staff are not safeguarding resident's property
INVESTIGATION FINDINGS:
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On 12/21/22 Licensing Program Analysts (LPAs) Joscelyn Martinez and Melissa Ruiz arrived at the facility to conduct an unannounced subsequent vist. Upon arrival LPAs met with administrator Aris Vergara and the purpose of the visit was explained.

Allegation: Resident is not allowed visitors

An interview with the Administrator and record review revealed that the Los Angeles County Public Health issued an Order instructing the facility to go into lockdown and deny visitation due to continuous active covid-19 outbreaks, ranging from different dated within the span of August 2021 – January 2022. Due to this information, the allegation mentioned above is Unsubstantiated.

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Joscelyn MartinezTELEPHONE: (818) 383-6108
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.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 31-AS-20220308153826
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: 12/21/2022
NARRATIVE
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Allegation: Resident not allowed privacy

It is alleged that staff will not allow R1 privacy when they have visitors. Interviews with two (2) staff revealed that staff will at times walk with the visitors to the resident’s room. Staff will then knock and open the door for the visitor. Once the visitor is inside the room staff will leave and inform the visitor if they need any assistance to look for them at the front desk. Interviews with staff also revealed that if a visitor is familiar with the resident’s room, they can walk themselves once they have check in at the front desk. Additionally, staff stated they always provide privacy to for residents who have visitors. R1 has a private room that will accord R1 with privacy during visitation visits. Interview with R1 revealed that they were not allowed visitors inside the room. R1 stated that visitors will be through the window due to Covid-19 precautions. Also, R1 stated their friend was denied entry to the facility but R1 was not able to provide an exact date of when this occurred. Due to the interviews conducted, there is not sufficient evidence to prove the allegation mentioned above may or may not have happened, therefore it is deemed Unsubstantiated.

Allegation: Staff are not safeguarding resident's property

It is alleged by that R1’s medication products are being taken from the room while R1 is sleeping. According to R1’s Admission Agreement, R1 is receiving Medication Management assistance. Per the admission agreement Medication Management includes ordering, storing, supervised distribution and administration of medication. Additionally, according to R1’s physician report, it is noted that R1 cannot mange their own treatment/medication/equipment. Interviews with staff revealed that if medication is found in R1’s room that has been sent to R1 by family member, staff’s protocol is to take the medication to the med-tech room. Staff will then log the item and lock the medication so it is not accessible to residents in care. Furthermore, any medication item including topical creams, eye drops, and over-the-counter medication cannot be administered without a doctor’s order. R1 also alleged that they had personal items such as clothing go missing. LPA collected R1’s Client/Resident Personal Property and Valuables (LIC 621). R1 did not have any property listed on the LIC 621 and contained R1’s signature stating they did not want to log any property. Based on interviews and document review this allegation is deemed Unsubstantiated at this time.

Exit interview conducted Report signed and delivered.

SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Joscelyn MartinezTELEPHONE: (818) 383-6108
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
LIC9099 (FAS) - (06/04)
Page: 2 of 2