197608267-9-11-2023-31-AS-TAGD-CWBUZ7-20231005160106

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 06/10/2023
Date Signed: 09/11/2023 02:41:56 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
04/15/2022 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20220415171745

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: 137	DATE:	06/10/2023
		UNANNOUNCED	TIME BEGAN:	08:24 AM
MET WITH:	Mary Jane Reyes - Resident Care Director		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff refused to lower resident's bed

Staff withheld resident's mail

Staff confiscated resident's personal items.

Resident was left in a soiled diaper for a long period of time

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegations. LPA met with Mary Jane Reyes and explained the reason for the visit.

LPA conducted physical plant tour at 8:50 AM, requested copies of facility documents relevant to the investigation at 9:45 AM, reviewed records between 10:00 AM to 11:30 PM and interviewed residents between 11:30 AM to 2:00 PM. Regarding the allegation that the staff refused to lower resident's bed, it was alleged that Staff #1 (S1) refused to adjust Resident #1 (R1)'s bed. LPA's record review today at 10:00 AM revealed that on 01/13/22, S1 called the Durable Medical Equipment (DME) company who provided R1's bed for adjustment and when the DME technician arrived, S1 was told that the bed was on its lowest level and could no longer be adjusted to a lower setting.

(continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2023

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-20220415171745

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: 06/10/2023

NARRATIVE

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Regarding the allegation that Staff withheld resident's mail, it was alleged that R1's mail was withheld because S1 thought the package contained pills. LPA's record review today at between 10:00 AM to 11:30 AM revealed that R1 was on medication management per physician's order, which means that the facility manages all of R1's medications including but not limited to prescription and over the counter (OTC) medications. Some of R1's mail and/or packages were OTC medication and therefore subject to verification and central storage if confirmed. LPA's interview with the Resident Care Director today at 12:00 PM revealed that staff do not open any mail of any resident and they only verify by asking and watching the mail/package opened by the recipient resident.

Regarding the allegation that Staff confiscated resident's personal items, it was alleged that the R1's personal items have been confiscated and not logged in such as oil, soaps, topical pain reliever, vitamins and OTC medications. LPA's record review today at between 10:00 AM to 11:30 AM revealed that R1 was on medication management per physician's order, which means that the facility manages all of R1's medications including but not limited to prescription and over the counter (OTC) medications. Further review also reveals that client/personal property and valuables (LIC 621) duly signed by R1 did not contain any personal belongings item. LPA's interview with the administrator on 05/13/23 at 11:00 AM revealed that during their meeting with R1 and R1's family member on 03/16/22, R1 and family member agreed to create an inventory of all the personal belongings of R1 and turn it over to the facility but when the private caregiver came to the facility to do the inventory, R1 refused but eventually got an ongoing inventory of R1's belongings until R1 left the facility. LPA's interview with the Resident Care Director today at 12:00 PM revealed that staff do not confiscate any personal items from any resident unless it is some form of medication, and the resident is in medication management.

Regarding the allegation that Resident was left in a soiled diaper for a long period of time, it was alleged that R1 was left in a soiled diaper for hours that has caused skin break down. LPA's record review revealed that R1 was being checked/changed regularly every two (2) hours and there was no record of R1 having a skin breakdown. Further review also revealed that R1 was on Hospice service and regularly visited by a Registered Nurse (RN). LPA's interview with six (6) incontinent residents today between 11:30 AM to 2:00 PM, revealed that all six (6) of them stated that staff check on them regularly and respond to their call within twenty (20) minutes. Based on the information gathered during this and prior visits, these allegations are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2023

LIC9099 (FAS) - (06/04)

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