197608267-8-30-2023-31-AS-NMAN-CVKN26-20230911100411

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 08/30/2023
Date Signed: 08/30/2023 04:45:45 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
11/30/2021 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20211130093134

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:	04:45 PM

ALLEGATION(S):

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Resident was not provided an admission agreement
Resident was not provided a proper medical assessment
Staff denied a resident from leaving the facility

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. LPA interviewed staff and residents from 11:50 a.m. to 4:00 p.m. and reviewed pertinent records at 1:00 p.m.

Regarding the allegation “Resident was not provided an admission agreement” it was alleged Resident #1 (R1) did not receive a copy of their Admission Agreement. Residents interviewed today from 11:50 a.m to 4:00 p.m. stated they or their families had received copies of their admission agreements. Marketing staff interviewed at 12:45 p.m. today stated the facility provides residents with a copy of their admission agreements during admission. Based on interviews of staff and residents, there is insufficient evidence to confirm the allegation above. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

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-20211130093134

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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Regarding the allegation “Resident was not provided a proper medical assessment” it was alleged R1 was not medically assessed around the time of admission. R1’s medical assessment was reviewed today at 1:00 p.m. From record review, R1’s medical assessment showed they were assessed by a physician approximately 3 months prior to admission. From interviews of staff and residents today between 11:50 a.m. and 4:00 p.m., staff stated no residents are admitted to the facility without a current medical assessment, and residents confirmed they had seen a physician around the time of admission. Based on interviews of staff and residents and records review, there is insufficient evidence to confirm the allegation above. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation “Staff denied a resident from leaving the facility” it was alleged Staff #1 (S1) denied R1 their request to leave the facility. S1 was not able to be reached for interview, so LPA interviewed facility staff and residents today from 11:50 a.m. to 4:00 p.m. From interviews, staff stated they respect residents’ right to freely leave the facility. If the resident requires assistance to leave the facility, staff attempt to redirect the resident or ensure the resident’s safety outside of the facility. Residents interviewed reported no issue with their ability to freely leave the facility. Based on interviews of staff and residents, there is insufficient evidence to confirm the allegation above. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

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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