197608267-1-4-2023-31-AS-NGID-CNPTNA-20230203135224

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 01/04/2023
Date Signed: 01/04/2023 03:00:23 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
12/19/2022 and conducted by Evaluator Joscelyn Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20221219103326

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:	12:00 PM
MET WITH:	Mary Jane Reyes		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff inappropriately handled resident in care.
Resident was assaulted by an unknown perpetrator.

INVESTIGATION FINDINGS:

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

Allegation: Staff inappropriately handled resident in care.
Allegation: Resident was assaulted by an unknown perpetrator.

It is alleged that staff inappropriatley handled resident and assulted R1 in care. To invesitgate these allegations LPA conducted interviews with two caregivers, three administrative staff, and R1. Interviews with caregivers and adimistrative staff revealed that R1 has not been inappropiralty handled nor assuslted by any staff at the facility. S4 stated that on 11/04/22 LAPD arrived at the facility regarding an elder abuse allegation pertaning to R1. LAPD left a note card stating there was no evidence of elder abuse and that resident had mental illness.

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)

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Control Number 31-AS-20221219103326

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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Interview with R1 revealed that staff has physically assaulted R1. When LPA asked if R1 called the police in regards to these allegations R1 stated no because they will get in trouble. LPA reminded R1 that R1 will not get in trouble if they call the police due to physical abuse but R1 stated that is not true. R1 stated they have no bruises on their body. LPA asked for the names of the staff who have assaulted R1, but R1 was unable to give LPA any details. 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.

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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