197608267-1-30-2024-31-AS-TAGD-D3KS8V-20240321133945

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 01/30/2024
Date Signed: 01/30/2024 02:13:27 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
01/23/2024 and conducted by Evaluator Gina Saucedo

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20240123163901

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: 128	DATE:	01/30/2024
		UNANNOUNCED	TIME BEGAN:	08:55 AM
MET WITH:	Kandice Vergara		TIME COMPLETED:	02:35 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff caused injury to resident
Staff is physically abusive to residents
Staff is verbally abusive to residents

INVESTIGATION FINDINGS:

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

On 01/30/24, at 0:855am, Licensing Program Analyst (LPA) Gina Saucedo conducted a subsequent, complaint investigation at the above facility to address the following allegation(s). LPA Gina Saucedo was met first by Mary Jane Reyes-Resident Care Director. LPA explained the purpose of this visit was to gather information, interviews and deliver findings for this complaint.

The investigation consisted of the following: on 01/24/24, LPA Saucedo initiated a complaint investigation. On 01/30/24, at 9:20am, LPA Saucedo toured the physical plant and requested records. The following records were requested: staff roster and resident roster. Additional records were also obtained regarding R1 R2: Needs and services plan, physician report, Identification and emergency contact information, resident information/care plan, preplacement appraisal, functional capability assesment and resident appraisal.

9099C-continued

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Gina Saucedo	TELEPHONE: (818) 304-3057
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

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-20240123163901

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: 01/30/2024

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

Regarding the allegation: Staff caused injury to resident. It is being alleged that the staff threw resident on the floor, they hit something and sustained “laceration” between their eyes above their nose. According to the interviews that the LPA conducted from the staff and the injury report obtained, the resident fell to the floor hitting their forehead against one of the metal chairs while the staff was preventing them from leaving the memory care unit, but this was not due to staff throwing them on the floor. The interview with the LVN also confirmed that when they saw and gave aid to R1, the gash obtained on R1’s forehead was bleeding and they asked R1 about the injury. R1 stated they fell. LPA was able to obtain a picture of R1’ injury on their forehead. LPA’s interview with the alleged staff confirms that R1 fell to the floor hitting their head while they were trying to hold R1 against one of the chairs in the dining hall so R1 would not leave the memory care area of the facility. According to the resident care director, R1 has a history of trying to leave the facility and go home. LPA attempted to interview R1 but R1 could not describe what happened that day. LPA obtained R1’s records stating that R1 is sometimes confused/disoriented due to their diagnosis.

Regarding the allegation: Staff is physically abusive to residents. It is being alleged that the staff hits residents and sprays residents with a water bottle. LPA was able to interview nine (9) out of eleven (11) residents and they all say that the staff does not physically abuse them. On the day of the incident, the alleged staff attempted to stop R1 from leaving the memory care unit but R1 became agitated. R1 has a history of wandering behavior. R1 wanted to leave the facility and continued to say they were leaving walking towards one of the exit doors. Once the alleged staff attempted to stop them from leaving the memory care unit, R1 fell to the ground and hit their head against the metal part of the chair. In addition, the LPA was also able to interview ten (10) out of eleven (11) staff that have confirmed that the alleged staff does not physically abuse the residents. Some staff also say that the alleged staff have trained them to do their job and have worked with that staff for many years with no issues. LPA was able to review the alleged staff’s file and made no observations of the staff being reprimanded for anything during their work history. LPA also interviewed the resident director and administrator where they state that there have been no reprimands and/or past allegations of this sort regarding the alleged staff. LPA was also able to obtain the police report where it states that R1 denied any abuse.

LIC 9099C-continued

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Gina Saucedo	TELEPHONE: (818) 304-3057
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 31-AS-20240123163901

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: 01/30/2024

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

Regarding the allegation: Staff is verbally abusive to residents. It is being alleged that the staff calls the residents inappropriate names. LPA was able to interview nine (9) out of eleven (11) residents and none of the nine (9) residents have heard or know of the staff being verbally abusive to them. In addition, the LPA was also able to interview ten (10) out of eleven (11) staff that have confirmed that the alleged staff does not verbally abuse the residents. They do admit that the alleged staff is very loud but that is the tone in their voice.

Based on the LPA's interviews, observations, and record reviews all three allegation(s) above are unsubstantiated at this time.

An exit interview was conducted, no citations were issued for the three (3) above allegations, and a copy of this report was given to the administrator.

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Gina Saucedo	TELEPHONE: (818) 304-3057
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 3