197608267-10-4-2023-31-AS-NGID-D59TEV-20240514144033

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 10/04/2023
Date Signed: 10/04/2023 02:56:57 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
09/28/2023 and conducted by Evaluator Angela Panushkina

COMPLAINT CONTROL NUMBER: 31-AS-20230928082308

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: 141	DATE:	10/04/2023
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Kandice Vergara, Administrator		TIME COMPLETED:	03:20 PM

ALLEGATION(S):

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Staff are selling illicit drugs.
Residents in care are using illicit drugs.
Staff failed to seek timely medical treatment.
Staff did not provide proper food service to resident in care
Staff is verbally abusive to resident in care
Staff did not safeguard resident's personal belongings

INVESTIGATION FINDINGS:

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At 10:30am, Licensing Program Analysts (LPAs) Angela Panushkina, Leslie Ngo-Castaneda and Huma Rahimi, conducted an unannounced initial complaint visit at this facility to investigate the above allegations. LPAs met with the Administrator and explained the reason for the visit.

During course of the investigation, interviews and record review were made. At 10:35am, LPAs requested resident and staff roster. At 10:40am, LPAs requested copies of pertinent information which include, but not limited to Admission Agreement, Physician’s Report, Appraisal Needs and Services Plan, etc., relevant to the investigation. At approximately 10:50am, LPA conducted a physical plant tour, to ensure health and safety of the residents are protected and physical plant is in compliance with Title 22 Regulations. Between 10:40am – 1:10pm, LPAs interviewed the Administrator, Resident Care Manager, three (3) staff and eleven (11) out of fourteen (14) residents residents.
Continue on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2023

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-20230928082308

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: CEDARS ASSISTED LIVING, THE	FACILITY NUMBER: 197608267
	VISIT DATE: 10/04/2023

NARRATIVE

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Allegation: Staff are selling illicit drugs.
To investigate this allegation LPAs conducted interviews with eleven (11) out of fourteen (14) residents and ten (10) out of fourteen residents denied ever witnessing facility staff selling illicit drugs. One (1) out of fourteen (14) residents informed LPAs that the facility staff sells illicit drugs. However, the resident never witnessed nor was able to provide a specific staff name. In addition, LPAs conducted Interviews with the Administrator, Resident Care Manager and three (3) staff members and all staff denied the above allegation. Therefore, based on interviews, LPAs did not have sufficient evidence to prove the allegation, and it’s UNSUBSTANTIATED at this time.

Allegation: Residents in care are using illicit drugs.
To investigate this allegation LPAs conducted interviews with eleven (11) out of fourteen (14) residents and ten (10) out of fourteen (14) residents denied ever using or witnessing other residents using illicit drugs. One (1) out of fourteen (14) residents informed LPAs that the facility residents use illicit drugs. However, the resident never witnessed nor was able to provide a specific resident name. In addition, LPAs conducted Interviews with the Administrator, Resident Care Manager and three (3) staff members and all staff denied witnessing residents using illicit drugs. LPAs were informed by the Administrator that due to weed being legal to use, the facility has one resident that uses weed in designated area only. Therefore, based on interviews, LPAs did not have sufficient evidence to prove the allegation, and it’s UNSUBSTANTIATED at this time.

Allegation: Staff failed to seek timely medical treatment.
To investigate this allegation LPAs conducted interviews with eleven (11) out of fourteen (14) residents informed LPAs that they feel very secured at this facility and that the staff always provides immediate assistance in case of an emergency. Moreover, LPAs conducted Interviews with the Administrator, Resident Care Manager and three (3) staff members and were informed that residents involved in any incident are assessed by the MedTech immediately to determine if 911 needs to be contacted. Therefore, based on interviews, LPAs did not have sufficient evidence to prove the allegation, and it’s UNSUBSTANTIATED at this time.

Allegation: Staff did not provide proper food service to resident in care.
To investigate this allegation, LPAs conducted interviews with eleven (11) out of fourteen (14) residents revealed that the facility provides three (3) meals and snacks in between every day. Moreover, LPAs were also informed that the staff will provide an extra meal upon request. During todays interview with R1, LPAs
Continue on LIC9099-C

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2023

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20230928082308

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: CEDARS ASSISTED LIVING, THE	FACILITY NUMBER: 197608267
	VISIT DATE: 10/04/2023

NARRATIVE

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witnessed a staff member bring lunch (soup, vegetables, toast, dessert, etc.) into R1's room. LPAs also witnessed R1 refused the lunch and requested the staff for the Peanut Butter and Jelly. Lastly, interviews with the Administrator, Resident Care Manager and three (3) staff members never had any concerns and that the staff will also customize food being served upon resident's request. Based on the information gathered during this visit, this allegation is deemed Unsubstantiated at this time.

Allegation: Staff is verbally abusive to resident in care
To investigate this allegation LPAs conducted interviews with eleven (11) out of fourteen (14) residents informed LPAs that they have not experienced or observed any facility staff to be verbally abusive to themselves or any other residents. Interviews of residents also revealed that they can always talk to staff without fear of retaliation or abuse. Several residents also indicated that facility staff are approachable, friendly, and nice. Moreover, LPAs conducted Interviews with the Administrator, Resident Care Manager and three (3) staff members and all staff denied the above allegation. LPAs were also informed that as soon as the staff observes resident being aggressive/combative/behavior episode, etc. they immediately call for help and change the staff member to avoid any complication. Therefore, based on interviews, LPAs did not have sufficient evidence to prove the allegation, and it’s UNSUBSTANTIATED at this time.

Allegation: Staff did not safeguard resident's personal belongings

During today's investigation, LPAs conducted interviews with eleven (11) out of fourteen (14) residents and ten (10) out of fourteen (14) residents expressed no concerns regarding this allegation. In addition, LPAs were informed that no personal belongings have been taken from them, and whatever was accidentally misplaced during the laundry, the resident received there belongings in a timely fashion. Moreover, interviews with R1 revealed that he/she observed one some of his/her clothes on another resident. However, R1 was unable to identify the resident nor provide specific items were missing. Lastly, interviews with the Administrator, Resident Care Manager and three (3) staff members revealed that a lot of times residents will misplace their belongings and find it later. Therefore, the allegation, resident's personal belongings were taken by staff, is deemed UNSUBSTANTIATED at this time.

No Deficiencies cited during today's visit.

Exit interview conducted and copy of this report signed and delivered.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2023

LIC9099 (FAS) - (06/04)

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