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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608267
Report Date: 07/07/2023
Date Signed: 07/07/2023 03:12:25 PM


Document Has Been Signed on 07/07/2023 03:12 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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



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: 137DATE:
07/07/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Mary Jane Reyes-Resident Care DirectorTIME COMPLETED:
03:00 PM
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On 7/7/23 Licensing Program Analysts (LPAs) Mariana Agban and Michael Cava conducted a Case Management visit to the facility. In conjunction to complaint control number 31-AS 20230323164836, LPAs needed to ensure that the facility has addressed the issue of rodents to ensure facility compliance with Title 22 Regulations and that the Health and Safety of the residents are protected. LPAs met with staff MJ Reyes and Richard, and advised them of the visit. Today's Case Management visit consisted of inspecting resident rooms 103, 119, 210, 219, 235, 250 and 251. LPAs also inspected the kitchen, dining room, activity room, laundry room, tv room, and stairwells. Per inspection of the physical plant, LPAs did not observe any immediate health and safety risk to the residents in care. Facility was observed to be clean, safe and sanitary at the time of the Case Management visit. In addition, during the visit LPAs obtained copies of invoice from Dewey Pest Control Company and confirmed that facility receives services twice a month. Review of these invoices do not indicate recent issues with rodents or insect infestation.

Based on the records obtained and a walk trough of the physical plant, facility appears to be compliant with regulations, therefore no deficiencies issued at this time.
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Mariana AgbanTELEPHONE: 818-738-4525
LICENSING EVALUATOR SIGNATURE:
DATE: 07/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/07/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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