197608267-3-14-2023-31-AS-EMIR-CTUPT4-20230718113520

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 03/14/2023
Date Signed: 03/14/2023 03:38:53 PM

Unsubstantiated

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
03/08/2023 and conducted by Evaluator Evelin Rios

COMPLAINT CONTROL NUMBER: 31-AS-20230308105130

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: 135	DATE:	03/14/2023
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Mary Jane Reyes		TIME COMPLETED:	03:50 PM

ALLEGATION(S):

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Staff did not assist resident in obtaining dental care
Staff are not assisting resident with ADLs
Staff are not cleaning resident's room

INVESTIGATION FINDINGS:

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On 03/14/23 Licensing Program Analyst (LPA) Evelin Rios arrived at the facility to conduct an unannounced complaint investigation visit for the allegations mentioned above. Upon arrival LPA met with Resident Care Director Mary Jane Reyes and LPA explained the purpose of the visit.

From approximately 9:45 a.m. to 11:00 a.m. LPA and Mary Jane Reyes conducted a physical plant tour of the facility to ensure the health and safety of the residents in care. Durng the same time LPA conducted interviews with 7 out of 135 residents in care, and toured resident's room. LPA also conducted interviews with Todd Anderson the Maintenance Director and Mary Jane Rayes. From approximately 11:00 a.m. to 11:40 a.m. LPA obtained and reviewed records relevant to this investigation. At 11:44 a.m. LPA interviewed resident #1 (R1), room was toured earlier but R1 was asleep. From approximately 11:52 to 12:30 p.m. LPA continued interviews with 5 more staff. At 1:35 LPA interviewed staff #1 by telephone.

(Continued on LIC 9099)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Evelin Rios	TELEPHONE: 424-299-6104
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023

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-20230308105130

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: 03/14/2023

NARRATIVE

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Allegation #1: Staff did not assist resident in obtaining dental care
It is alleged R1 asked the staff to take him to the dentist and the staff did not. To investigate this allegation LPA interviewed 8 residents, 3 staff that provide assistance to R1 and reviewed records. Admissions agreement revealed and Mary confirmed facility will assist residents in receiving medical care and transportation to medical appointments if residents or resident's family request it. Interview with R1 revealed he could not chew his food due to tooth pain and had told a female staff. R1 could not remember the name of the person or describe them. Interview with 3 out of the 3 staff revealed R1 did not complain about tooth pain or let them know he could not chew his food properly. Interview with 2 out 8 residents who stated they have been to medical appointments recently state they had a family member take them and 2 out of the 8 state they have informed staff to make an appointment. Based on the information obtained, there was insufficient evidence to confirm the allegation occurred. Therefore this allegation is deemed Unsubstantiated at this time.

Allegation #2 Staff are not assisting resident with ADLs
It is alleged R1 is not receiving help with hygiene such as brushing teeth, showers and toileting. To investigate allegation LPA reviewed R1's records which revealed R1 requires assistance with showering, grooming, personal hygiene and escorting/transfers due to fall risk. Further, records reveal R1 is able to care for their own toileting needs. Facility records reveal services needed by residents are displayed for staff such as caregivers and med-techs to follow. Interview with S1 revealed R1 has refused to shower if S1 is not the one assisting. S2 confirmed R1 has refused showering because they did not want S2's assistance. R1 corroborated they prefer to be assisted by S1 only. R1 revealed in interview they brush their own teeth. LPA reviewed daily activity log, where caregivers document activities completed or refused by residents in care. Based on the information obtained, there was insufficient evidence to confirm the allegation occurred. Therefore this allegation is deemed Unsubstantiated at this time.

Allegation #3: Staff are not cleaning resident's room
It is alleged that R1's room and bathroom are dirty. To investigate this allegation LPA took a tour of R1's bedroom and observed bedroom to be clean and clear of clutter. LPA observed the bathroom to have a clean disposable incontinence pad on the floor and urine in the toilet bowl. LPA's interview with R1 and review of R1's records revealed R1 is able to take care of toileting needs.

(Continued on LIC9099C)

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Evelin Rios	TELEPHONE: 424-299-6104
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20230308105130

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: 03/14/2023

NARRATIVE

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(Continued LIC9099C)

Interview with 2 out of the 3 caregivers who provide direct care to R! revealed that R1 uses the bathroom on their own but they will see urine on the floor and have to clean it up. Caregivers also revealed they place a pad on the floor to prevent R1's roommate from slipping on urine if it ends up on the floor. Based on the information obtained, there was insufficient evidence to confirm the allegation occurred. Therefore this allegation is deemed Unsubstantiated at this time.

Exit interview conducted. Report signed and delivered.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Evelin Rios	TELEPHONE: 424-299-6104
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023

LIC9099 (FAS) - (06/04)

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