197608267-8-16-2023-31-AS-NMAN-CZLSAU-20240118124256

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 08/16/2023
Date Signed: 08/16/2023 04:26:43 PM

Substantiated

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
08/14/2023 and conducted by Evaluator Antonia Alvizar

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20230814152134

FACILITY NAME:	CEDARS ASSISTED LIVING, THE		FACILITY NUMBER:	197608267
ADMINISTRATOR:	KANDICE VERGARA		FACILITY TYPE:	740
ADDRESS:	17300 ROSCOE BLVD.		TELEPHONE:	(818) 344-2042
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91325
CAPACITY:	175	CENSUS: 143	DATE:	08/16/2023
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:			TIME COMPLETED:	04:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility is not meeting fire code

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Antonia Alvizar conducted an unannounced subsequent complaint visit to deliver the finding for the above stated allegation. At 3:30PM LPA met with the Administrator, Kandice Vergara and explained the reason for the visit.

Concerns were addressed that the facility is in violation of the Fire Codes. Licensee disregard the notices of violations received from Los Angeles Fire Department (LAFD) and no corrections were made.

An initial complaint visit was conducted on 8/15/23 at which time, 2:10pm Licensing representative and Fire inspectors Linsay Pellegrini and Ben Guzman with the assistance of the Administrator and Assistant Administrator inspected the facility. All issues/violations of the Fire Codes were noted. According to the Absolute Fire protection has not been scheduled for a Fire Regulation 4 testing. At approximately 1:53PM the Fire Watch log is reviewed by fire inspector and appeared to be incorrect. The log was never reported to the Fire Department as it was required.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Antonia Alvizar	TELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 31-AS-20230814152134

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: 08/16/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Based on inspection, observation, interviews and record review, there is a sufficient information and evidence to support the allegation. Therefore, the allegation is substantiated at this time.

The Administrator was informed that non-compliance with the Codes and Regulations enforced by the Fire Department is posing an immediate health and safety risk to residents in care. Therefore, an immediate civil penalty of $500.00 will be issued at the time of this visit.

Under title 22, Division 6, Chapter 8, following deficiencies were cited and recorded on LIC9099D

Exit interview was conducted with Kandice, appeal rights discussed, and a copy of report was issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Antonia Alvizar	TELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 31-AS-20230814152134

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/16/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 08/16/2023 Section Cited CCR 87203	1 2 3 4 5 6 7	87203 Fire Safety- All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement is not met as evidenced by. The licensee did not ensure that the facility manintains conformity with	1 2 3 4 5 6 7	Administrator has agreed to provide daily update via-email to Fire Dapartment and Community Care Licensing. Administrator also agreed to submit Fire Watch logs every Friday afternoon until Regulation 4 test is conducted.
	8 9 10 11 12 13 14	Regulations enforced by Fire Department. The violations of the fire codes noted by Fire inspector were not completed. This possesses an immediate health and safety risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Antonia Alvizar	TELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 3