197608267-4-2-2024-31-AS-TAGD-D48SWQ-20240411141442

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 04/02/2024
Date Signed: 04/02/2024 02:50:48 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
03/27/2024 and conducted by Evaluator Gina Saucedo

COMPLAINT CONTROL NUMBER: 31-AS-20240327121941

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: 123	DATE:	04/02/2024
		UNANNOUNCED	TIME BEGAN:	09:55 AM
MET WITH:	Mary Jane Reyes		TIME COMPLETED:	03:05 PM

ALLEGATION(S):

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Staff did not ensure that resident's personal possessions were safeguarded.

INVESTIGATION FINDINGS:

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On 04/02/24, at 9:55am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, initial complaint visit and was greeted by Resident Director Mary Jane Reyes. LPA disclosed the purpose of the visit. LPA explained the purpose of this visit was to gather information, conduct interviews and deliver findings for this complaint.

The investigation consisted of the following: LPA Saucedo asked for the census, requested the staff and resident roster. At 10:20am, LPA toured the physical plant. During the tour, twelve (12) residents and five (5) staff were interviewed.

LIC 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: 04/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2024

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-20240327121941

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: 04/02/2024

NARRATIVE

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Regarding the allegation: It is being alleged that a resident's (R1) fanny pack disappeared from their room and reappeared weeks later with a large sum of money still missing. Eleven (11) out of twelve (12) residents were able to confirm that they have never had any items stolen from their room especially money. It was also confirmed that Eleven (11) out of twelve (12) residents are aware of the Theft and Loss Policy. In addition, five (5) out of five (5) staff are aware of the Theft and Loss Policy. Five (5) out of five (5) staff confirmed that they helped search for the missing items in (R1)’s room and documented it. LPA obtained all four (4) written documents and the Unusual Incident/Injury Report from the Resident Director that was sent to the Licensing Department stating the loss of the item(s). LPA also obtained R1's Client/Resident Personal Property and Valuables and the Cash Resources from the Admission Agreement stating that the facility does not maintain or supervise resident cash resources. LPA also reviewed the Theft and Loss Policy that was posted at the facility. Therefore, based on the LPA's interviews and observations the above allegation(s) above is unsubstantiated at this time.

An exit interview was conducted, no citations were issued for the above allegation(s), and a copy of this report was given to the Executive Director.

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Gina Saucedo	TELEPHONE: (818) 304-3057
LICENSING EVALUATOR SIGNATURE:	DATE: 04/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2024

LIC9099 (FAS) - (06/04)

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