197606902-1-24-2024-31-AS-MVAO-D2MVGV-20240220152607

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606902
Report Date: 01/24/2024
Date Signed: 01/24/2024 12:21:35 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-20240123090839

FACILITY NAME:	OLIVE BRANCH ASSISTED LIVING, THE		FACILITY NUMBER:	197606902
ADMINISTRATOR:	CHARLES ARRIETA		FACILITY TYPE:	740
ADDRESS:	10215 BALBOA BLVD.		TELEPHONE:	(818) 368-8581
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91325
CAPACITY:	146	CENSUS: 85	DATE:	01/24/2024
		UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Charles Arrieta		TIME COMPLETED:	12:40 PM

ALLEGATION(S):

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Staff are screaming at the residents
Staff are mistreating a resident while in care

INVESTIGATION FINDINGS:

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On 01/24/24, at 08:50 am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, initial complaint visit and was greeted by Administrator-Charles Arrieta. LPA disclosed the purpose of the visit. 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 asked for the census, requested the staff and resident roster. At 9:45am, LPA toured the physical plant, conducted staff and resident interviews.

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: 01/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

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-20240123090839

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: OLIVE BRANCH ASSISTED LIVING, THE	FACILITY NUMBER: 197606902
	VISIT DATE: 01/24/2024

NARRATIVE

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Regarding the allegation: Staff are screaming at the residents. It’s being alleged that the screaming of staff is "shrill" and it triggers R1's PTSD. Based on the LPA record review, R1 has an Impacted cerum of bilateral ears and was diagnosed with sensorineural hearing loss. LPA's staff and resident interviews also determined that staff do not scream at the residents. Eight (8) out of eight (8) residents that were interviewed determined that they are treated well including R1. R1 admitted that they cannot hear well and their hearing aids were stolen at the last facility that they lived in. R1 has been requesting new hearing aids through the Veteran Affairs help. Staff also confirm that R1 has lost several hearing aids. LPA also observed that R1 could not hear them and had to repeat some questions several times. Based on staff and resident interviews, and LPA record's reviews the allegation(s) above is unsubstantiated at this time.

Regarding the allegation: Staff are mistreating a resident while in care. It is being alleged that staff is mean to R1 and other residents. Based on the staff and resident interviews it is determined that staff are not mean to the residents. Eight (8) out of eight (8) residents confirmed that the staff treat them with respect. One resident (R2) claims, " if you do what you should be doing no one bothers you here, it is really laxed." R1, also confirmed that one of the caregivers treats him really well. The caregiver showers R1 when R1 wants to be showered and the caregiver also gives R1 haircuts. Based on LPA's staff and resident interviews, the 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: 01/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

LIC9099 (FAS) - (06/04)

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