197608267-5-13-2024-31-AS-MVAO-D5WV9R-20240604161445

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 05/13/2024
Date Signed: 05/13/2024 01:55:04 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
05/08/2024 and conducted by Evaluator Gina Saucedo

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20240508141207

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: 125	DATE:	05/13/2024
		UNANNOUNCED	TIME BEGAN:	09:55 AM
MET WITH:	Kandice Vergara		TIME COMPLETED:	02:10 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Illegal eviction

INVESTIGATION FINDINGS:

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

On 05/13/24, at 9:55am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, initial complaint visit and was greeted by Activites Director, Tabetha Whitehall. 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 10:25am, LPA toured the physical plant. During the tour, twelve (12) residents and three (3) staff were interviewed.

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: 05/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2024

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 2

Control Number 31-AS-20240508141207

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: 05/13/2024

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: Illegal eviction. It is being alleged that a resident is saying staff is trying to make an example of them, to their peers and to their fellow patients by evicting them. Eleven (11) out of twelve (12) residents were able to confirm that they do not have any issues following the house rules. Eleven (11) out of the twelve (12) residents confirmed that they are aware of the admission agreement, and they also confirmed they are aware of the eviction rules. Two (2) residents confirmed that they have observed resident #1 (R1) using illegal drugs on facility grounds. LPA’s interview with R1 confirmed that their behavior did not comply with general policies of the facility. Two (2) out of three (3) staff confirmed that they were present when they serviced R1 with the appropriate eviction notice. Three (3) out of three (3) staff are aware of the house rules and eviction policy. On April 16, 2024, the resident director and the Activities director were witness to the resident signing the proof of service regarding eviction regarding illegal drug use in the facility. In addition, the administrator provided the resident with the proper reasoning of eviction explaining that drug use is a concern to health and safety code, there is a zero-tolerance policy for risking the lives of residents with this type of behavior. On April 17, 2024, LPA received the appropriate eviction notice of R1 via fax through Community Care Licensing Department (CCLD) and within the proper days of notice. On April 10, 2024, via fax/CCLD, LPA received an Unusual Incident/Injury reported stating that R1 refused to go to the hospital when the paramedics were called because R1 was overdosing on illegal drugs at the above facility and the paramedics had to administer Narcan. LPA’s interview with the administrator confirmed that placement has been found for R1 through the Assisted Living Waiver program. LPA also obtained R1’s admission agreement and house rules signed by R1 on 05/29/2023. Therefore, based on the LPA's record reviews, staff and resident’s interviews the above allegation(s) above is unsubstantiated at this time.

An exit interview was conducted, no citations were issued for above allegation(s), 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: 05/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2