197608267-7-7-2023-31-AS-EMIR-CU6MFW-20230728093457

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 07/07/2023
Date Signed: 07/07/2023 02:50:46 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
03/07/2023 and conducted by Evaluator Michael Cava

COMPLAINT CONTROL NUMBER: 31-AS-20230307105837

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: 137	DATE:	07/07/2023
		UNANNOUNCED	TIME BEGAN:	09:13 AM
MET WITH:	MJ Reyes		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Resident developed possible sepsis while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Michael Cava conducted a subsequent visit to the facility to deliver the findings regarding the above allegation. It was reported that due to neglect, resident was admitted to the hospital for being Bradycardic Hypotensive, and having altered mental status and sepsis. The complaint was referred to Investigations Branch (IB) on 03/07/23, and accepted as a full investigation. It was assigned to investigator Olivia Spindola. The ten (10) day visit was initiated by LPA Cava on 03/08/23. IB’s investigation consisted of interviews with facility staff, Resident 1’s (R1) family, and obtaining R1’s hospital records for review.

On 03/29/23, Investigator Spindola interviewed the facility’s Resident Care Director, Staff 1 (S1) and Staff 2 (S2). Interviews conducted by investigator Spindola reveal no indication that R1 developed sepsis due to neglect.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
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.

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20230307105837

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: 07/07/2023

NARRATIVE

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On 04/05/23, IB conducted a record review of hospital records from Kaiser Permanente. Although there was mention of hospitalization for sepsis in the past, there was no indication of neglect. Furthermore, record review also revealed that R1 was taking multiple antipsychotics which can precipitate hypothermia “and may be the underlying etiology of R1’s hypothermia”.

On 04/20/23, IB conducted a record review of hospital records from Northridge Hospital. R1 was admitted for altered mental status, but there was no indication of neglect. R1 was noted to be hypotensive and unresponsive in route to the hospital.

On 05/18/23, Investigator Spindola interviewed facility Med Tech/Staff 3 (S3), who stated that R1 “was in general poor health”. S3 stated that on 03/03/23, R1 wouldn’t eat, and vitals were low. The Fire Department was called to take R1 to the hospital because EMT would not.

On 05/18/23, Investigator Spindola interviewed R1’s family. They gave no indication of neglect while R1 was under the care of the facility.

Based on the information obtained by IB, through interviews and hospital record review, there was insufficient evidence to corroborate that allegation of R1 developing sepsis while in care. “Although R1 was hospitalized with chronic sepsis and was Bradycardic Hypotensive, according to R1’s medical records, it was medications that precipitated the hypothermia and R1 had a medical history of chronic sepsis”. Therefore, the allegation is deemed Unsubstantiated at this time.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
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

LIC9099 (FAS) - (06/04)

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