197608267-5-20-2023-31-AS-NMAN-CWFJYR-20231009072818

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 05/20/2023
Date Signed: 05/20/2023 02:19:41 PM

Unsubstantiated

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
08/12/2022 and conducted by Evaluator Tihesha Smith

COMPLAINT CONTROL NUMBER: 31-AS-20220812144318

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: 138	DATE:	05/20/2023
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Mary Jane Reyes		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff impede LTCO's ability to investigate resident concerns

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tihesha Smith made an unannounced subsequent complaint visit to this facility at 8:00 am. LPA Smith met with facility staff and disclosed the purpose of this visit. The administrator was unavailable, so Wellness Director contacted and arrived at 10:00 am.

During initial visit, on 08/16/22, LPA Jocelyn Martinez met with administrator upon arrival, conducted tour of physical plant and requested documents relevant to the investigation at approximately 12:00 pm.
During subsequent visit 05/15/23, LPA Tihesha Smith conducted interviews with staff, reviewed facility records, and requested documents relevant to the investigation from approximately 10:03 AM – 12:55 pm.
On 05/20/23, LPA Smith interviewed staff and residents from approximately 8:20 am - 11:30 am.

Staff impede LTCO's ability to investigate resident concerns
It was alleged that facility staff impede LTCO's ability to investigate Resident #1 (R1) concerns.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Tihesha Smith	TELEPHONE: 818-307-6280
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2023

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-20220812144318

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: 05/20/2023

NARRATIVE

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(Cont from 9099)

Interviews with Executive Director and administrator conducted on 05/15/23 revealed that ombudsman did not follow proper protocol when requesting medical records, facility documents, in addition to facility census. Interview with three (3) out of three (3) staff on 05/15/23 and 05/20/23 reveal that the ombudsman’s request for R1’s medical documents were not made with the administrator and did not include written consent at time of the request.

Based on interviews during this and previous licensing visits there is insufficient pertinent information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

Exit Interview conducted. Copy of report issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Tihesha Smith	TELEPHONE: 818-307-6280
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2023

LIC9099 (FAS) - (06/04)

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