<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 04/17/2023
Date Signed: 04/18/2023 04:36:17 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 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
03/23/2023 and conducted by Evaluator Antonia Alvizar
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20230323164836
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: 132DATE:
04/17/2023
UNANNOUNCEDTIME BEGAN:
10:12 AM
MET WITH:Administrator, Aristotle B. VergaraTIME COMPLETED:
03:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff did not ensure the facility was free from rodents
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
At 10:30am Licensing Program Analyst (LPA) Antonia Alvizar conducted an unannounced subsequent complaint visit to deliver the fining for the above stated allegation. LPA met with the Administrator and explained the reason for the visit.

It was alleged that facility has rodents. Rodents’ droppings were observed in the kitchen and in the room #235.
An initial complaint visit conducted on 03/29/23.
During initial visit LPA conducted a physical plant walk through, at approximately 10:35am, at which time LPA inspected facility kitchen and residents’ rooms, including room 235. At the time of room inspection, four (04) Residents were interviewed. On 03/29/2023, between 11:00am -3:35pm LPA Alvizar conducted interviews with the Administrator and other staff including Maintenance Director. LPA also obtained copies of pertinent documents at 12:45pm.
Continue on LIC9099-C

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Antonia AlvizarTELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2023
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 5
Control Number 31-AS-20230323164836
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: CEDARS ASSISTED LIVING, THE
FACILITY NUMBER: 197608267
VISIT DATE: 04/17/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
At the time of inspection, LPA observed rodent droppings, glue traps underneath resident’s bedrooms sink and kitchen sink. Interview with resident revealed that there are rats in the facility.

Interview with all staff members, confirmed that the facility has rodents. The facility hired a pest control company that have been treating the rodents but unsuccessful.

A review of facility records verified the information revealed from interviews.

Based on interviews, observation, and document review, there is a sufficient information to support the allegation. Therefore, this allegation is deemed Substantiated.



Deficiencies were issued and recorded on LIC9099D.

No health and safety hazard were noted during this visit.

Exit interview conducted. Report signed and delivered. Appeal rights delivered.
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Antonia AlvizarTELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 31-AS-20230323164836
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: CEDARS ASSISTED LIVING, THE
FACILITY NUMBER: 197608267
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/29/2023
Section Cited
CCR
87303(a)
1
2
3
4
5
6
7
87303(a) The facility shall be clean, safe, sanitary... at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees, and visitors. This requirement is not met as evidenced by: Based on inspection, and observation
1
2
3
4
5
6
7
The Administrator will take all measures to maintain the facility free from rodents. Administrator will submit updated documentation of Pest Control service agreement to LPA via fax.
8
9
10
11
12
13
14
the Licensee did not ensure that the facility is safe and sanitary for wellbeing of residents and others. LPA observed rodent droppings in residents’ bedrooms. This poses a potential health, safety risk and personal rights violation to residents in care.
8
9
10
11
12
13
14
On 4/17/23 all measures to prevent rodents from entering resident’s bedroom where taken. LPA observed residents bedroom clean and holes on walls were covered. LPA received Pest Control Invoice indicating aggressive steps for fumigation. POC cleared during this visit.
Type B
03/29/2023
Section Cited
CCR
80076(a)(17)
1
2
3
4
5
6
7
80076(a)(17) Food Service. Kitchens, food preparation, and storage areas shall be kept clean... free of rodents, and other vermin. This requirement is not met as evidenced by: Based on inspection, and observation the Licensee did not ensure that the kitchen was free from rodents.
1
2
3
4
5
6
7
The Administrator will instruct staff to cover holes on the wall to maintain the kitchen free from rodents. Adminstrator will submit updated documentation of Pest Control service agreement to LPA via fax.
8
9
10
11
12
13
14
 LPA observed rodent droppings inside the kitchen. This poses a potential health, safety risk and personal rights violation to residents in care.
8
9
10
11
12
13
14
On 4/17/23 LPA Alvizar observed holes on wall covered with aluminum sheets underneath the kitchen sinks. LPA received Pet Control Invoice indicating five (5) more Inspection and Treatment services added per month. POC cleared during this visit.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Antonia AlvizarTELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 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
03/23/2023 and conducted by Evaluator Antonia Alvizar
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20230323164836

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: 132DATE:
04/17/2023
UNANNOUNCEDTIME BEGAN:
10:12 AM
MET WITH:Administrator, Aristotle B. VergaraTIME COMPLETED:
03:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is in disrepair
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Antonia Alvizar made an unannounced complaint visit to this facility. LPA met Administrator and explained that this visit was to conduct an investigation of the above noted allegation.

It was alleged that facility is in disrepair. The plumbing fixtures and water lines are in disrepair.

During this investigation, on 03/29/2023 LPA conducted a physical plant tour at approximately at 11:00 am – 12:10 pm and inspected the kitchen, bedroom #235, and four (04) randomly selected residents’ bedrooms located on the 2nd floor. During the inspection, LPA Alvizar interviewed three (3) out of hundred and twenty (120) residents including resident #.1 (R1). In addition on 03/29/2023, LPA interviewed facility staff between 11:00am to 12:10pm and requested copies of pertinent documents at 12:45 pm.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Antonia AlvizarTELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 31-AS-20230323164836
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: CEDARS ASSISTED LIVING, THE
FACILITY NUMBER: 197608267
VISIT DATE: 04/17/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Upon facility inspection, in the kitchen LPA Alvizar observed total of four (04) sinks; The water pressure was checked and LPA did not notice any issues.
Interview of residents did not reveal any concerns regarding facility plumbing fixtures.
Staff interviews revealed that the facility’s plumbing fixtures are not in disrepair. There is a total of four (4) sinks in the kitchen. Three (3) out of four (4) sinks provide normal water pressure and only one (1) sink has low water pressure.. A review of facility maintenance records did not provide any information to confirm that there was a problem with plumbing fixtures.
Based on inspection, observation, and interviews there is no pertinent information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.


Exit interview was conducted and a copy of the report was issued.
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Antonia AlvizarTELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5