197608267-12-21-2022-31-AS-NGID-CNST8J-20230206133022

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 12/21/2022
Date Signed: 12/21/2022 03:38:51 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
02/23/2022 and conducted by Evaluator Joscelyn Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20220223092208

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:	12/21/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Aris Vergara		TIME COMPLETED:	03:50 PM

ALLEGATION(S):

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Adequate food service is not provided to residents
Staff are not safeguarding residents property
Staff are not returning residents belongings
Staff denied resident the ability to receive visitors.
Staff not treating resident with respect

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: Adequate food service is not provided to residents

According to staff interview, breakfast is served between 8:00-8:30 a.m, lunch is served between 11:30 a.m and 12:30 p.m, and dinner is served between 4:30-5:30 p.m. According to S1 R1 is usually served first. At times R1 refuses to eat the food that is available that day and chooses to have food that R1 has in their room. S1 stated at times R1 is sleeping during the hours food is being delivered and R1 has stated they request the food to be brought back at a later time. Based on interviews 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: 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)

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Control Number 31-AS-20220223092208

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: Staff 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.

Allegation: Staff are not returning residents belongings.

It is alleged that staff are not returning the medication items that have been removed from R1's room. Interview with administrator stated that on 03/05/22 the facility had a meeting in regards to R1's complaints about the facility. At this meeting R1's song was present and staff returned the boxed items that were mailed to R1 containing medication. These medication were over-the-counter medications that did not contain a doctor's order therefore, the facility was unable to administer the medication to R1.Interview with R1 revealed that from their knowledge the items taken from R1's room had not been return to R1's family members. Based on interview this allegation is deemed Unsubstantiated.

Allegation: Staff denied resident the ability to receive 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.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Joscelyn Martinez	TELEPHONE: (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)

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Control Number 31-AS-20220223092208

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: Staff not treating resident with respect

On 2/21/22, R1 alleged that staff had not changed their diaper during the night shift. Staff member (S1) went to talk to R1 regarding this allegation, and the Reporting Party alleged that R1 felt patronized and teased. During a conversation with R1, S1 stated that if the allegation was true, the staff member who did not change R1 would get written up. R1 then rescinded their statement to S1 and stated that they had been changed and had simply “forgotten”. Lastly, S1 denied disrespecting R1 verbally. Based on interviews 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: 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)

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