197608267-10-4-2023-31-AS-RORN-D59QMS-20240514121758

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608267
Report Date: 10/04/2023
Date Signed: 10/04/2023 02:22:57 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
06/08/2022 and conducted by Evaluator Michael Cava

COMPLAINT CONTROL NUMBER: 31-AS-20220608164259

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: 141	DATE:	10/04/2023
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Kandace Vergara		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff have mismanaged resident's Social Security funding.
Resident is not receivng their personal needs income as required.
Resident's accounting records are not being maintained properly.
Resident's Representative is not being communicated to by staff in a timely manner.
Facility is preventing the Long Term Care Ombudsman from resolving complaints involving resident.
Facility is preventing the Long Term Care Ombudsman from examining resident's records at the facility.

INVESTIGATION FINDINGS:

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

Licensing Program Analysts (LPAs) Chris Alemoh and Michael Cava conducted a subsequent complaint visit to the facility to conclude the investigation regarding the above allegations. LPAs met with the administrator, Kandace Vergara, and advised her of the complaint. Today's investigation consisted of an interview with the administrator and record review. A physical plant inspection was also made.

Facility staff have managed resident's Social Security funding/Resident is not receiving their personal needs income as required/Resident's accounting records are not being maintained properly:
In regards to the allegation, it was reported that facility started the process to become payee for Resident 1 (R1) on or around July 2021. Since that time, R1 stopped receiving their personal needs money and all social security payments. As a result, R1's family and friends were using their own money to purchase R1's personal items since there is no money being given to the resident.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
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)

Page: 1 of 3

Control Number 31-AS-20220608164259

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

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

On or around March 3, 2022, LTCO met with R1 and confirmed that R1 had "no idea" where their money was and had not received "any money in a very long time".

According to the administrator, the facility didn't handle R1's finances until June 1, 2022. Prior to that, R1's monies were deposited directly into their personal bank account. R1's family would then pay the facility, via check, their rent on the due date. Facility only received payment from May 2021 to July 2021, and then stopped receiving rental payment from R1's family. The last payment received from R1 was June 1, 2022, for $626.21. R1 left the facility after June 1, 2022. R1 currently has an overdue balance of approximately $14,980. Review of R1's records indicate that R1's monthly rent is $1070 per month. The statements from the business office confirm that payment was only received from May 2021 to July 2021. LPAs also reviewed a letter from Social Security Administration indicating that R1's SSI will be sent to the facility as of June 1, 2022. Based on the information received, it could not be proven that facility staff have managed R1's Social Security funding, R1 is not receiving their personal needs income as required and R1's accounting records are not being maintained properly. Therefore, the allegations are deemed Unsubstantiated at this time.

Resident's Representative is not being communicated to by staff in a timely manner:
In regards to the allegation, it was reported that no one from the facility had informed R1 or their family about R1's account and or rent being behind and not receiving monies for their Personal Needs Income (PNI).

According to the administrator, the facility didn't help handle R1's finances until June 1, 2022. R1 is in the Assisted Living Waiver program (ALW). Although finances weren't being handled by the facility, email notification was getting sent to the ALW program and R1's family, advising them of R1's overdue payments. Review of R1's records confirm notification was getting sent. LPAs obtained copies of these email notification. Based on the information obtained, there was insufficient evidence to prove that R1's representative is not being communicated in a timely manner. Therefore, the allegation is deemed Unsubstantiated at this time.

Facility is preventing the Long Term Care Ombudsman from resolving complaints involving resident/Facility is preventing the Long Term Care Ombudsman from examining resident's records at the facility:
In regards to the allegations, it was reported that the facility has willfully interfered, impeded, and prevented

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
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)

Page: 2 of 3

Control Number 31-AS-20220608164259

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

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

the ombudsman from resolving the resident's complaints. The facility has also willfully prevented and interfered with examination of the resident's personal records in order to carry out the ombudsman's responsibilities. Interviews with the administrator and Staff 1 (S1) deny the allegation. Both stated they cooperated with the ombudsman's investigation. Pursuant to WIC, medical or personal records of a patient could only be provided by the facility to any entity only with the expressed written consent of the patient/resident. Administrator stated that they received instruction not to provide any resident's personal and/or medical information/document to anyone without the consent of the resident. Based on the information obtained, there was insufficient evidence to prove that the facility is prevented the Long Term Care Ombudsman from resolving complaints involving resident and the facility prevented the Long Term Care Ombudsman from examining resident's records at the facility. Therefore, the allegations are deemed Unsubstantiated at this time.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
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)

Page: 3 of 3