197608267-10-28-2020-31-AS-JAPL-BUVQ6Q-20201030115353

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 10/28/2020
Date Signed: 10/28/2020 03:48:18 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/14/2020 and conducted by Evaluator Ashley Smith

COMPLAINT CONTROL NUMBER: 31-AS-20200514134611

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: 120	DATE:	10/28/2020
		UNANNOUNCED	TIME BEGAN:	03:05 PM
MET WITH:	Aris Vergara		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Facility staff failed to safeguard resident's valuables.
Facility staff did not communicate promptly and appropriately to the resident's representatives.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ashley Smith conducted a subsequent complaint to the above facility. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted virtually via FaceTime with Aris Vergara. The purpose of the virtual visit is to delivering findings for an investigation initiated and conducted by LPA Amin.

The investigation included interviews with the administrator on 5/21/20 at 2:18 pm and the wellness coordinator on 6/15/20 at 10:42 am. Interviews with R1’s family members were conducted on 5/19/20 at 2:07 pm. and on 5/29/20 at 3:25 pm. LPA Amin reviewed R’s physician report, admission agreement and Client/Resident Personal Property and Valuables form (LIC 621) on 6/10/20 at 2 pm. The hospice nurse was interviewed on 5/19/20 at 10 am.

CONT 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2020

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-20200514134611

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: CEDARS ASSISTED LIVING, THE	FACILITY NUMBER: 197608267
	VISIT DATE: 10/28/2020

NARRATIVE

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Regarding the allegation: Facility staff failed to safeguard resident's valuables.
It was alleged that Resident#1's (R1's) personal belongings were not secured after the death of the resident. R1's gold wedding band was reported missing. Records review revealed that the Client/Resident Personal Property and Valuables form (LIC 621) for R1 was completed and the gold wedding band was listed on the document. Furthermore, interviews with family members indicated that they received a call from staff who detailed the items for pick up that they gathered from R1’s room after R1’s death yet the gold wedding band was not on that list. The family informed them that the gold ring is the only thing they will pick-up; and, that the other items can be donated to whomever can use it. The ring was last observed by a family member on 3/11/20, during their visit. There were no visits after that, due to the COVID-19 pandemic. They inquired about the ring with the mortuary and were told that there was no ring on R1’s finger when they picked up the body.
Interviews with the administrator revealed that R1 passed away in the evening of 4/22/20. The next day, the administrator and other staff gathered all R1's belongings from the room for the responsible person to pick up, as the family was not allowed inside the facility due to the COVID-19 visitation policy. However, the administrator stated that in other circumstances, the responsible person would come in to pick up the resident's belongings. Interview conducted with the administrator further revealed, upon discovering the missing ring, he interviewed the staff members who may have been involved with R1's care and the hospice staff. However; no one was aware of R1's gold ring and no one recalled when was the last time they observed the ring on R1's finger. LPA Amin conducted an interview with the hospice staff who stated that on 4/22/20, they visited R1 at 3:30 p.m. R1 passed at 7:30 p.m. They were informed and hospice staff arrived at the facility to prepare the body for pickup, however they do not recall observing the ring on the finger.

On 6/15/20 at 10:42 am, LPA Amin spoke with Wellness Coordinator who also stated they don’t recall seeing the ring on R1’s finger; and, they were not present at the facility at the time of R1’s death or when the mortuary picked up the body. They searched the room upon discovering that R1’s ring was missing; however, they were not able to locate the ring in the room. On 6/26/20, LPA Amin attempted to interview the staff who was present at the time of R1’s death; however, was unable to do so as that staff was part-time employee and no longer work for the facility.

CONT 9099-C

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2020

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20200514134611

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: CEDARS ASSISTED LIVING, THE	FACILITY NUMBER: 197608267
	VISIT DATE: 10/28/2020

NARRATIVE

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On 6/26/20 at 3pm, more than two months after R1’s passing, LPA Amin was informed by the family member that the administrator called them stating the ring has been found and that they picked it up. The family member also confirmed, that is was R1’s ring, but they were still upset that they had to go through this on the top of the grief from losing R1.

The fact is that the facility did not secure R1’s belonging after the death, as the ring was not found until more than two months after R1’s passing. Therefore, the above allegation “Facility staff failed to safeguard resident's valuables" is substantiated at this time. In addition, upon discovering the missing gold ring, the administrator did not report the missing item to the police department and failed to submit the incident report to the licensing office as per regulation, which will be addressed on separate case management visit.

Regarding the allegation: Facility staff did not communicate promptly and appropriately to the resident's representatives.

It is alleged that the facility’s administrative staff did not return R1’s family’s call and failed to communicate with R1’s family members appropriately and after the administrative staff were informed about Resident #1’s (R1’s) missing wedding ring. Interviews with R1’s family members revealed that many phone messages were left for the administrator at the front desk; however, no one returned the family’s call after R1 passed away on 4/22/20. LPA Amin was informed that due to the sentimental value of R1’s wedding ring, it was important to R1’s spouse to receive it, as the couple were married for more than 60 years and R1 was very adamant about not taking it off for any reason. LPA Amin reviewed the messages sent to the administrator, requesting an answer as to if they found the ring; however, no one responded to their messages. In addition, LPA Amin also learned that family was also upset about facility staff just leaving a voice mail message for R1’s spouse to informed them about the death of R1. The staff did not communicate properly with the family member to break the news of the passing of their loved one at the facility.

Based on the information obtained, it is evident that the administrator failed to communicate with R1’s family promptly and appropriately after the death of R1. Therefore; the allegation is substantiated at this time.

Pursuant to Title 22 of the CA Code of Regulations, the following deficiency was cited (refer to LIC 9099-D). Exit interview conducted. Appeal rights provided. A copy of report sent via email for signature.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2020

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20200514134611

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: CEDARS ASSISTED LIVING, THE	FACILITY NUMBER: 197608267
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/28/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/04/2020 Section Cited CCR 87217(j)	1 2 3 4 5 6 7	Safeguards for Resident Cash, Personal Property, and Valuables. (j) Upon the death of a resident, all cash resources, personal property, and valuables of that resident shall immediately be safeguarded. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	The Administrator has agreed to do the following: 1. Submit a Plan of Action, detailing how the facility will ensure that resident personal property is safeguarded. Submit plan to CCLD no later than 11/4/2020
	8 9 10 11 12 13 14	Based on the interviews and record review, the licensee did not comply with the section cited above, as the licensee did not ensure that R1’s personal property was secured immediately after the death, which poses a potential personal rights risk to residents in care.	8 9 10 11 12 13 14
Type B 11/04/2020 Section Cited CCR 87468.1(a)(9)	1 2 3 4 5 6 7	Personal Rights of Residents in All Facilities (a) Residents in all facilities for the elderly shall have all the following personal rights: (9) To have communications to the licensee from their representatives answered promptly and appropriately. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	The Administrator has agreed to do the following: 1. Review Regulation 87468. Submit Statement of Understanding, detailing how the facility will maintain compliance to CCLD by 11/4/2020.
	8 9 10 11 12 13 14	Based on the interviews and record review, the licensee did not comply with the section cited above, as the licensee did not communicate appropriately and in timely manner with R1’s family member after the death of R1. This poses a potential personal rights risk to residents in care.	8 9 10 11 12 13 14

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: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2020

LIC9099 (FAS) - (06/04)

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