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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608267
Report Date: 08/01/2023
Date Signed: 08/02/2023 07:28:21 AM


Document Has Been Signed on 08/02/2023 07:28 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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: 140DATE:
08/01/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Mary Jane ReyesTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Melissa Spaeth conducted an unannounced case management visit and was greeted by staff. LPA stated the purpose of the visit. An incident report was received on 7/23/2023 stating a resident (R1) had exited out of memory care wing through the resident's room. The night-shift staff conducted a bed check at 5:00 am and reported the resident was in their room. The day shift staff conducted a bed check at 6:20 am and found the resident was not in the room.

Staff immediately searched for R1 and discovered R1 had pushed open the window and the screen had also been pushed out. Staff immediately began the search procedures which included checking the entire building, outside area, each resident's room, and staff drove within the neighborhood searching for the resident. After completing all the search steps, 911 was called at 8:20 am and the police arrived 9:10 am. Flyers were distributed throughout the area. Police has conducted a thorough search for the resident. Staff has contacted all hospitals within the area to continue the search for the resident.. Police have kept in contact with facility staff. Staff also called the former DHS case manager and received the brother's contact information. Staff immediately called the brother but brother did not return the call.

On 7/26/2023, R1's brother called and stated R1 is fine. R1 asked brother to call the facility to let staff know R1 is fine and did not return to the facility. Facility staff called R1's brother to find out how to reach R1 and find out where R1 is living. However, R1's brother has not returned the staff's phone call. The police officer was contacted and was provided with the contact information.

There are no deficiencies to report at this time. Exit interview conducted, and a copy of the report was given to staff member.
SUPERVISOR'S NAME: Troy AgardTELEPHONE: (818) -596-4334
LICENSING EVALUATOR NAME: Melissa SpaethTELEPHONE: (818) 421-2278
LICENSING EVALUATOR SIGNATURE:
DATE: 08/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/01/2023
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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