197608267-4-14-2021-31-AS-CHAS-C34V7U-20210517161144

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 04/14/2021
Date Signed: 04/14/2021 12:54:26 PM

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
03/30/2021 and conducted by Evaluator Wendell Smith

COMPLAINT CONTROL NUMBER: 31-AS-20210330141617

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: 102	DATE:	04/14/2021
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Lourdes Kazdan		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Facility refused to take resident back after hospitalization.
Facility staff did not safeguard resident's personal belongings.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Wendell Smith conducted a subsequent complaint visit. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted by telephone.

Regarding the allegations above previous visits were conducted on 4/2/21 and 4/8/21. It is alleged that facility refused to take resident #1 (R1) back after hospitalization. LPA conducted interviews with R1, facility staff, and hospital staff. Information from interviews reveal that the facility did not refuse to take R1 back from the hospital but that R1 refused to go back to the facility. Based on the information obtained through interviews this allegation is deemed Unsubstantiated at this time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Wendell Smith	TELEPHONE: (818) 738-4525
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2021

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-20210330141617

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: 04/14/2021

NARRATIVE

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Facility staff did not safeguard resident's personal belongings
It is alleged that facility did not safeguard R1's belongings. LPA conducted interviews with facility staff and R1 regarding this allegation. Information obtained from interviews reveal that since R1 has left the facility R1's belongings are still at the facility and no one has come to pick them up. Facility is not holding R1's belongings from them, it's just that R1 has not arranged for their belongings to be picked up. Based on information obtained through interviews this allegation is deemed Unsubstantiated at this time.
Exit interview conducted. Copy of report issued through email for signature.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Wendell Smith	TELEPHONE: (818) 738-4525
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2021

LIC9099 (FAS) - (06/04)

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