197608267-1-4-2023-31-AS-NGID-CNENBW-20230125091948

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 01/04/2023
Date Signed: 01/04/2023 02:53:30 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
12/27/2022 and conducted by Evaluator Joscelyn Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20221227085809

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: 125	DATE:	01/04/2023
		UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Mary Jane Reyes		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff threaten resident
Staff do not assist resident with incontinence needs
Staff do not assist resident with hygiene needs
Staff do not feed resident
Staff do not assist resident with laundry

INVESTIGATION FINDINGS:

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On 01/04/22 Licensing Program Analyst (LPA) Joscelyn Martinez arrived at the facility to conduct an unannounced complaint investigation visit. Upon arrival LPA met with Resident Care Director Mary Jane Reyes. The purpose of the visit was explained.

Allegation: Staff threaten resident

It is alleged that staff are verbally threatening R1 while in care. To investigate this allegation LPA interviewed three administrative staff, two caregivers, and R1. Interviews with staff revealed that they do threatened staff nor have they witness any staff verbally or physically threatening R1. Additionally staff stated that R1 has many outbursts in where R1 will become verbally aggressive with caregivers and administrative staff. Interview with R1 revealed that R1 is being threatened by staff but when LPA asked for more details R1 was unable to provide any. R1 stated they do not know the names of the staff that made these threats. R1 then stated every staff has threaten R1. Based on the information obtained, there was insufficient evidence to confirm the allegation occurred. This allegation is deemed Unsubstantiated at this time.

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: 01/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2023

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 3

Control Number 31-AS-20221227085809

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: 01/04/2023

NARRATIVE

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Allegation: Staff do not assist resident with incontinence needs
Allegation: Staff do not assist resident with hygiene needs

It is alleged that staff do not provide assistance with incontinence needs and bathing. To investigate these allegations, LPA interviewed two caregivers that provide assistance to R1 and three administrative staff. Interviews with caregiver revealed that R1 does not let staff change nor bath them. Caregivers stated R1 will refuse and start yelling at staff when they offer assistance. S1 stated this morning they had a difficult time changing R1 because they refused to be changed even though R1's diaper was wet. S1 stated R1 will refuse to some shower but S1 will try to provide other alternatives for R1's hygiene such as a deodorant or a wet cloth to wipe R1. S2 stated that R1 will only let S3 bath them. S2 stated that S3 will bath R1 every Friday but refuses to be bathe on their second day of scheduled showers. Interview with R1 revealed that staff do not shower them nor do they change R1. R1 stated they have to take care of their own incontinence needs because staff do not assist R1. LPA obtained a shower scheduled for R1. Document review revealed that R1 is scheduled for showers every Fridays and Sundays. Based on the information obtained, there was insufficient evidence to confirm the allegations occurred. These allegations are deemed Unsubstantiated at this time.

Allegation: Staff do not feed resident

It is alleged that staff do not feed R1. Interviews with R1 revealed that R1 is able to go to the dinning room to eat. At 1:10 p.m LPA interviewed R1. R1 stated that they had not ate breakfast nor lunch. LPA asked if R1 is able to feed themselves and R1 stated yes. R1 asked if they require room service delivery for food and R1 stated no. LPA asked R1 i if they were hungry LPA can get a staff to take them to the dining room and R1 stated no. Interviews with R1's caregiver of the day, S1, revealed that they had taken R1 to the dining room for breakfast and lunch. During the time of the interview with S1, S1 stated that R1 was currently in the dining room having lunch. S1 stated that R1 eats very well and staff will assist by wheeling R1 to the dining room area to eat. S2 stated they will also take R1 to the dining room area and R1 eats at the facility all three meals. Interviews with three administrative staff revealed that R1 is assisted by caregivers to go to the dining room. R1 is able to self feed and does not need assistance eating. Based on interviews this allegation is deemed Unsubstantiated.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Joscelyn Martinez	TELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2023

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20221227085809

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: 01/04/2023

NARRATIVE

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Allegation: Staff do not assist resident with laundry

It is alleged that staff are not assisting R1 with laundry service. Interview with R1 revealed that staff do not help R1 with laundry. LPA observed R1's belongings in boxes and suitcases. When LPA asked why their belongings are in boxes, R1 stated because they will be leaving soon. LPA asked if R1 has any dirty clothes at the moment and R1 stated no. Interviews with R1's caregiver revealed that R1 refuses any staff to touch their belongings. When staff come in to collect the dirty clothes to wash, R1 will hide them and refuse to give them to staff. Interview with S4 revealed that R1 gets their laundry washed every Friday afternoon but R1 refuses most of the time. Interview with S2 revealed that about 15 days ago staff had a big load of laundry to wash for R1 because R1 will refuse staff to touch the clothing. Once washed S2 stated they offer R1 help to put the clothes away but R1 refused and still has the washed clothes in the bag. Based on interviews and observation this allegation is deemed Unsubstantiated.

Exit interview conducted. Report signed and delivered.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Joscelyn Martinez	TELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2023

LIC9099 (FAS) - (06/04)

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