197608267-7-29-2023-31-AS-TAGD-CWXRXV-20231025132521

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 07/29/2023
Date Signed: 07/29/2023 03:13:57 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
08/17/2022 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20220817144856

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: 148	DATE:	07/29/2023
		UNANNOUNCED	TIME BEGAN:	08:39 AM
MET WITH:	Maryjane Reyes - Resident Care Director		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not provide toileting items as required

Staff did not meet a resident's hygiene needs while in care

Staff did not provide access to a resident's personal records

Staff interfered during a complaint investigation

INVESTIGATION FINDINGS:

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

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

LPA conducted physical plant tour at 9:01 AM, requested copies of facility documents relevant to the investigation at 9:38 AM and interviewed staff and residents between 10:00 AM to 12:45 PM and reviewed records between 1:00 PM to 2:30 PM. Regarding the allegation that staff did not provide toileting items as required, it was alleged that Resident #1 (R1) was running low on diapers and wipes. LPA's record review today between 1:00 PM to 2:30 PM revealed that R1 was under a hospice care and all the toileting supplies were supplied by the hospice agency. LPA's interview with Resident Care Director today at 10:00 AM also revealed that R1 talked directly to the hospice agency for supplies but former Resident Care Director also made numerous follow up and the agency always bring R1 hygiene supplies. (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: 07/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2023

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 2

Control Number 31-AS-20220817144856

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: 07/29/2023

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

(continued from LIC 9099)

Regarding the allegation that Staff did not meet a resident's hygiene needs while in care, it was alleged that R1 did not have a full bath in over a year. LPA's record review today between 1:00 PM to 2:30 PM revealed that R1 was under a hospice care and all the toileting supplies were supplied by the hospice agency. LPA's interview with Resident Care Director today at 10:00 AM also revealed that R1 talked directly to the hospice agency for R1's bathing schedule. Further review of hospice record revealed that there are times that R1 refused shower during scheduled shower visit by the hospice agency.

Regarding the allegation that Staff did not provide access to a resident's personal records, it was alleged that staff refused to provide any documentation for R1. LPA's interview with the Resident Care Director (RSD) today at 10:00 AM revealed that the RSD only abided Administrator's instruction not to provide any resident's document to anyone without the consent of the resident because it may violate Health Insurance Portability and Accountability Act (HIPAA) and Welfare and Institutions Code (WIC). Further, when given the consent form, all the documents requested were handed over to the requesting party.

Regarding the allegation that Staff interfered during a complaint investigation, it was alleged that staff have repeatedly impeded the investigation regarding R1's concerns by not providing personal information of R1.
LPA's record review today between 1:00 PM to 2:30 PM revealed that per WIC, medical or personal records of a patient could only be provided by the facility to any entity only with the expressed written consent of the patient/resident. LPA's interview with the Administrator today at 12:05 PM revealed that it was the Administrator's instruction not to provide any resident's personal and/or medical information/document to anyone without the consent of the resident.

Based on the information gathered during this and prior visit, 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: 07/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2