197608267-8-30-2023-31-AS-NMAN-CVKM5S-20230911091850

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 08/30/2023
Date Signed: 08/30/2023 04:47:10 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
08/17/2022 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20220817143833

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: 143	DATE:	08/30/2023
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Mary Jane Reyes		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Staff interfered during a complaint investigation

INVESTIGATION FINDINGS:

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At 11:45 a.m. on 08/30/2023 Licensing Program Analyst (LPA) Nicholas Reed conducted a subsequent complaint visit. LPA met with Resident Care Director Mary Jane Reyes and disclosed the reason for the visit. At 12:20 p.m. LPA and Director Reyes toured the facility. No immediate health and safety concerns were observed.

Regarding the allegation "Staff interfered during a complaint investigation", it was alleged that staff had repeatedly impeded the investigation regarding R1's concerns by not providing personal information of R1. LPA Gary Tan previously investigated the allegation on 07/29/2023. LPA Tan requested copies of facility documents relevant to the investigation at 9:38 AM and interviewed staff and residents between 10:00 AM to 12:45 PM and reviewed records between 1:00 PM to 2:30 PM.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

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-20220817143833

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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, THE	FACILITY NUMBER: 197608267
	VISIT DATE: 08/30/2023

NARRATIVE

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LPA Tan’s record review on 07/29/2023 between 1:00 PM to 2:30 PM revealed that per WIC, medical or personal records of a patient could only be provided by the facility to any entity only with the expressed written consent of the resident. LPA Tan’s interview with the Administrator on 07/29/2023 at 12:05 PM revealed that it was the Administrator's instruction not to provide any resident's personal and/or medical information/document to anyone without the consent of the resident.

Based on the information gathered during this and prior visit, the allegation is deemed UNSUBSTANTIATED at this time.

Exit interview conducted. Appeal rights discussed. Copy of this report issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

LIC9099 (FAS) - (06/04)

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