197606902-3-14-2023-31-AS-NMAN-D3GMMX-20240318094438

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606902
Report Date: 03/14/2023
Date Signed: 03/14/2023 04:24:30 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
02/02/2023 and conducted by Evaluator Tihesha Smith

COMPLAINT CONTROL NUMBER: 31-AS-20230202133910

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: 75	DATE:	03/14/2023
		UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Charles Arrieta		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff are not properly assessing residents before admissions
Staff are not ensuring resident's attend scheduled medical appointments
Staff does not ensure residents had adequate medications.
Staff does not ensure resident has adequate clothing.
Staff are not properly trained.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tihesha Smith conducted a 10-day complaint visit to this facility on 03/14/23 at 10:10 am to deliver findings.
During initial visit, on 02/07/23, LPA Smith conducted a physical plant tour at 9:40 am, conducted interviews with staff/residents, requested and reviewed pertinent documents relevant to the investigation from 9:15 am-2:40 pm.

The following one out five allegations for Complaint Control #: 31-AS-20230202133910;
Staff are not properly assessing residents before admissions.
was delivered on 02/07/23 and the allegation was deemed UNSUBSTANTIATED

Staff are not ensuring resident's attend scheduled medical appointments.
During the course of the investigation LPA conducted interviews with administrator and facility staff.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Tihesha Smith	TELEPHONE: 818-307-6280
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023

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-20230202133910

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: OLIVE BRANCH ASSISTED LIVING, THE	FACILITY NUMBER: 197606902
	VISIT DATE: 03/14/2023

NARRATIVE

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(Cont from 9099)
Interview with administrator revealed that he and medication department ensure that all residents attend their medical appointments and have transportation available for all medical appointments. Interview with medication department supervisor revealed residents receive medical appointments via an appointment card through postal service including phone calls directly to the resident that medical staff aren’t made aware until the day of appointment.
Medication department supervisor also revealed that appointment cards received through the postal service are held at the Medication office, then each resident is contacted by medication staff that an appointment card was received, and they will need to report to the medication office and are encouraged at their discretion to open the appointment card and add/update appointments with the medication department. Per administrator the medication department also tracks all residents’ appointments using an outlook calendar. LPA observed outlook appointment calendar.

Based on the information obtained through interviews and observation this allegation is deemed Unsubstantiated at this time.

Staff does not ensure residents had adequate medications
It was alleged that staff does not ensure residents have adequate medications. Interviews with medication department supervisor reveal that during preadmission's and periodically medical records/medical prescription lists are received and reviewed and ordered based on prescription instructions and if incomplete medications are received. LPA observed prescription medication list and corresponding medications on hand.

Based on the information obtained through interviews and observation this allegation is deemed Unsubstantiated at this time

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Tihesha Smith	TELEPHONE: 818-307-6280
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20230202133910

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: OLIVE BRANCH ASSISTED LIVING, THE	FACILITY NUMBER: 197606902
	VISIT DATE: 03/14/2023

NARRATIVE

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(Cont from 9099C)

Staff does not ensure resident has adequate clothing.

LPA conducted interviews with staff and residents. Five (5) out of eight (8) residents interviewed revealed that clothing is provided, and the facility has regular outings for shopping. Interview with activity coordinator revealed facility receives donations and if a resident arrives without any clothing they are either provided clothing from the in-house donations pool or activity coordinator goes and purchases clothing at the Salvation Army center located approximately 300 ft from facility.

Based on the information obtained through interviews this allegation is deemed Unsubstantiated at this time.

Staff are not properly trained

It is alleged that staff are not properly trained. LPA reviewed six (6) random staff records from 11:15 am-12:10 pm. A review of staff records reveals that facility staff have received appropriate training's to include but not limited to: Direct care staff continuing training, dementia training, medication procedures and hospice training.

Based on the information obtained through record review this allegation is deemed Unsubstantiated at this time.

Exit interview conducted/Copy of report given

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Tihesha Smith	TELEPHONE: 818-307-6280
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023

LIC9099 (FAS) - (06/04)

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