197608267-2-26-2024-31-AS-NMAN-D33T29-20240305132022

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 02/26/2024
Date Signed: 02/26/2024 05:56:46 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.RO, 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
02/23/2022 and conducted by Evaluator Antonia Alvizar-Ettima

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20220223100228

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:	02/26/2024
		UNANNOUNCED	TIME BEGAN:	04:45 PM
MET WITH:	Resident Care Director, Mary Jane Reyes		TIME COMPLETED:	06:15 PM

ALLEGATION(S):

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Staff intimidating a resident
Staff do not repositioned resident
Staff do not assist resident with incontinence needs timely resulting in a rash
Staff are not safeguarding a resident's property

INVESTIGATION FINDINGS:

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At 4:45p.m. Licensing Program Analyst (LPA) Antonia Alvizar-Ettima conducted an unannounced complaint visit to deliver the finding for the above noted allegations. At 4:50p.m. LPA met with Resident Care Director, Mary Jane Reyes and explained the reason for the visit.

During initial visit conducted on 02/25/22 at 9:25am Licensing Program Analysts (LPA) Shira Stamps conducted a physical plant tour, interviewed facility staff, and collected relevant records.
During subsequent visit conducted on 03/14/22 at 10:30am LPAs Shira Stamps and Joscelyn Martinez arrived at the facility. LPAs conducted a physical plant walk through, interviewed additional staff and residents’, and collected relevant documents.
Prior to this visit on 02/26/2024 LPA Antonia Alvizar-Ettima reviewed the information and the documents previously gathered by other LPAs on 02/25/22 and 03/14/2022.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima	TELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024

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-20220223100228

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: CEDARS ASSISTED LIVING, THE	FACILITY NUMBER: 197608267
	VISIT DATE: 02/26/2024

NARRATIVE

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1. Staff intimidating a resident.

It was alleged that R1 was told by the administrative personnel that staff #1 (R1) is being written up for helping R1.

During previously conducted interviews, the Wellness Coordinator and Administrator denied writing up S4. S4 was interviewed and denied being written up. R1 was unable to provide specific details to explain who told R1 that S4 will be written up and why? A review of facility records including S4’s file, did not reveal any sufficient information to support the allegation. Therefore, based on interviews and record review the allegation is unsubstantiated at this time.

2. Staff do not repositioned resident

It was alleged that staff do not sit up or turn R1.

Staff interviews revealed that residents are being repositioned every two (2) hours and after meals. All residents interviewed including R1 did not address any concerns about turning and reposition or transfer assistance. Resident #9 (R9) stated staff never reposition them. However, per resident’s file review R9 is not identified as a bedridden resident requiring turning and repositioning. A review of R1’s record revealed that R1 is non-ambulatory and does not require turning and repositioning in bed. Staff is assisting them to transfer in and out of bed.

Based on interviews and record review, there is no sufficient information to verify the allegation. Therefore, the allegation is unsubstantiated at this time.
3. Staff do not assist resident with incontinence needs timely resulting in a rash

It was alleged that staff are changing R1 once or twice during a 24-hour time frame causing R1 to have a rash on bottom.

Staff interviews revealed that incontinent residents are being changed three (3) to four (4) times a day or as needed. During facility internal investigation, R1 indicated to staff that they were changed, but not by S4. R1 was changed by another staff. Other residents revealed that staff changes them three (3) times a day, and more often if needed.

A review of facility incontinent log supported the information provided by staff and residents.
No information was available during this investigation to confirm the allegation. Therefore, the allegation is unsubstantiated at this time.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima	TELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20220223100228

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: CEDARS ASSISTED LIVING, THE	FACILITY NUMBER: 197608267
	VISIT DATE: 02/26/2024

NARRATIVE

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4. Staff are not safeguarding a resident's property
It was alleged that staff are taking R1 over the counter medications and ointments.

Staff revealed that R1 is the only resident that reports things missing. When residents’ things are missing the policy of theft is to investigate what resident brought and logged in. Staff also revealed that residents are not allowed to keep over the counter medications or ointments in their possession. The medication is distributed to the residents by the facility staff. R1 indicated that they were never given a paper to list their personal items. Other residents revealed that they never had their items go missing.

A review of R1’s record revealed that R1 did not report their personal belongings.
No supporting information was available during this investigation to verify the allegation.
Therefore, based on interviews and record review, the allegation is unsubstantiated at this time.
No immediate health and safety hazard is noted during this visit.

Exit interview conducted with Resident Care Director, Mary Jane Reyes and a copy of this report was provided.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima	TELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024

LIC9099 (FAS) - (06/04)

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