197608267-8-31-2023-31-AS-NMAN-CVKN25-20230911100411

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 08/31/2023
Date Signed: 08/31/2023 03:55:44 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:	08/31/2023
		UNANNOUNCED	TIME BEGAN:	03:20 PM
MET WITH:	Mary Jane Reyes		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility has inadequate record keeping for a resident
Resident is not allowed to seek timely medical attention

INVESTIGATION FINDINGS:

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At 3:20 p.m. on 08/31/2023 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. on 08/30/2023 LPA and Director Reyes toured the facility. No immediate health and safety concerns were observed. LPA interviewed staff and residents on 08/30/2023 from 11:50 a.m. to 4:00 p.m. and reviewed pertinent records on 08/30/2023 at 1:00 p.m. LPA reviewed additional records today at 3:30 p.m.

Regarding the allegation “Facility has inadequate record keeping for a resident” it was alleged the facility did not maintain records for Resident #1 (R1). Record reviews on 08/30/2023 at 1:00 p.m. and today at 3:30 p.m. revealed the facility did maintain R1’s records of admission and medical files. Interview with Staff #1 (S1) on 08/30/2023 at 12:45 p.m. revealed the facility maintained R1’s records in a locked storage closet. Based on interviews and record review, 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: 08/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023

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: 08/31/2023

NARRATIVE

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Regarding the allegation “Resident is not allowed to seek timely medical attention”, it was alleged R1 was not reassessed by a physician in a timely manner. Record review on 08/30/2023 at 1:00 p.m. revealed R1’s medical assessment was current upon admission. An additional record review today at 3:30 p.m. revealed the facility had ensured R1 was reassessed by a physician in a timely manner. Interview with the Resident Care Director today at 3:45 p.m. confirmed the facility arranged for R1 to be reassessed in a timely manner. Based on interviews and record review, there is insufficient evidence to confirm the allegation above. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Exit interview conducted. Appeal rights discussed. Copy of report provided.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023

LIC9099 (FAS) - (06/04)

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