197608267-8-16-2023-31-AS-NMAN-CZLS84-20240118123832

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 08/16/2023
Date Signed: 08/16/2023 03:33:09 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
08/14/2023 and conducted by Evaluator Antonia Alvizar

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20230814122154

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:	03:10 PM
MET WITH:			TIME COMPLETED:	03:40 PM

ALLEGATION(S):

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Staff do not prevent resident from engaging in physical altercations with another resident in care

INVESTIGATION FINDINGS:

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At 3:10PM Licensing Program Analyst (LPA) Antonia Alvizar conducted an unannounced subsequent complaint visit to deliver the finding for the above stated allegation. LPA met with the Administrator, Kandice Vergara and explained the reason for the visit.

It was alleged that staff do not prevent resident from engaging in physical altercations with another resident in care. Resident was assaulted by another resident and staff do not do anything about it.

An initial complaint visit conducted on 8/15/23 at which time, 2:10PM LPA, Alvizar, LPM N. Gillyard and RM A. Kendrick, tour the physical plant, including Memory Care Unit and resident room 129. At the time of the inspection, two (2) resident and three (3) staff were interviewed. Staff indicated that some of the residents in Memory Care have impaired memory due to their medical diagnosis. Staff revealed that they have not witnessed any physical altercation amongst residents.

Unsubstantiated

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)

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Control Number 31-AS-20230814122154

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

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Per staff, if resident engage in physical altercations, staff try to maintain them separate, keep a closer eye on them and report incidents to the management. Resident #1 (R1) stated that they were not engaged in physical altercation with other residents. At approximately 3:00PM LPA Alvizar and LPM Gillyard reviewed facility files and did not observe any incident report regarding residents being engaged in physical altercation. Records revealed that residents residing in memory care, do not require close (one-on- one) supervision.

Based on observation, interviews and documents review there is an insufficient information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

Exit interview conducted with Kandice and a copy of this record provided.

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)

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