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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197606902
Report Date: 03/26/2024
Date Signed: 03/26/2024 02:51:17 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
02/01/2024 and conducted by Evaluator Gina Saucedo
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20240201103107
FACILITY NAME:OLIVE BRANCH ASSISTED LIVING, THEFACILITY NUMBER:
197606902
ADMINISTRATOR:CHARLES ARRIETAFACILITY TYPE:
740
ADDRESS:10215 BALBOA BLVD.TELEPHONE:
(818) 368-8581
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY:146CENSUS: 85DATE:
03/26/2024
UNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Charles ArrietaTIME COMPLETED:
03:05 PM
ALLEGATION(S):
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Staff is mishandling a resident's personal funds
Staff do not keep a resident's room free from odor
Staff do not provide laundry services for a resident
Staff do not properly maintaining a resident's bathroom
Staff inappropriately locked a resident's sliding door
Staff do not meet a resident's hygiene needs
Staff do not ensure a resident is being properly fed while in care
Staff do not properly maintain the facility grounds
INVESTIGATION FINDINGS:
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On 03/26/24, at 11:35am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, subsequent 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 additional information, conduct more interviews and deliver findings for this complaint.

On 02/06/2024, LPA Saucedo initiated the complaint investigation. On 02/13/24, LPA conducted a subsequent visit to gather additional information. On 03/26/24, the investigation consisted of the following: LPA Saucedo asked for the census, requested the staff and resident roster. At 11:45am, LPA toured the physical plant. During the tour, additional interviews were conducted.


LIC 9099C-continued
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy AgardTELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Gina SaucedoTELEPHONE: (818) 304-3057
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2024
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 4
Control Number 31-AS-20240201103107
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: 03/26/2024
NARRATIVE
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Regarding the allegation: Staff is mishandling a resident's personal funds. It is being alleged that the resident is taken shopping weekly with their own allowance. LPA was able to review Resident #1 (R1)’s record of client/resident’s safeguard cash resources dating 2024, 2023, 2022 and 2021 where it shows the handling of R1’s personal funds. LPA was also able to review rental payments paid by the conservator. R1 as of July 18, 2017, had a conservator. The assistant administrator did state that the above facility does provide transportation to the residents if they want to go shopping for themselves and use their own funds. Six (6) out of eight (8) residents confirmed that they can go shopping if they want with their own money. Four (4) out of four (4) staff confirmed that shopping is allowed by the residents if they have money. Therefore, based on the LPA's interviews, observations and record reviews the above allegation(s) above is unsubstantiated at this time.

Regarding the allegation: Staff do not keep resident’s room free from odor. It is being alleged that RP states the Resident #1(R1)’s smelled terrible. During LPA’s physical tour, LPA did not observe any odor that smelled terrible in the common areas. LPA also toured both of R1’s room the previous and the new room in which no odor that smelled terrible was observed/smelled in any of the rooms. Six (6) out of eight (8) residents were able to confirm that their room is cleaned daily. Four (4) out of four (4) staff confirmed that the rooms are cleaned daily. Therefore, based on the LPA's interviews and observations the above allegation(s) above is unsubstantiated at this time.

Regarding the allegation: Staff do not provide laundry services for resident. It is being alleged that the RP stated that Resident #1(R1) rarely gets a bath and their clothes laundered. RP states they have pictures of R1 wearing the same thing for months. LPA was able to obtain two pictures that RP had originally sent and R1 had two different clothes on. LPA visited R1 twice and R1 was not wearing the same clothing. On one occasion, R1 was wearing a green jacket with a green shirt under it and the other picture showing R1 wearing a tan, long sleeve with blue jean pants. In addition, the Admission Contract states “under Laundry” that for a fee of $30.00 per month the above facility may wash a resident’s clothes. It also states that if residents are found to be unable to take care of their chores due to health or physical disabilities, the above facility will assist. Six (6) out of eight (8) residents were able to confirm that their laundry services are met. Four (4) out four (4) staff did confirm that housekeeping and hospice care service were being provided to R1 daily because of their terminal/hospice illness. Therefore, based on the LPA's interviews, observations, and record review the above allegation(s) above is unsubstantiated at this time.

LIC 9099C-continued

SUPERVISOR'S NAME: Troy AgardTELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Gina SaucedoTELEPHONE: (818) 304-3057
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 31-AS-20240201103107
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: 03/26/2024
NARRATIVE
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Regarding the allegation: Staff do not properly maintain resident’s bathroom. It is being alleged that RP stated there were piles of dirty diapers next to a dirty bathtub. LPA was able to observe the previous room and the new room of Resident #1(R1) and there were no dirty diapers or/and dirty bathtub. During the physical tour, LPA also observed the housekeepers and caregivers cleaning different rooms including R1’s room. Six (6) out of eight (8) residents were able to confirm that their room is cleaned by staff. Four (4) out of four (4) staff confirmed that they do clean all the rooms daily. LPA also took a picture of the bathroom not having any dirty diapers on the floor. Therefore, based on the LPA's interviews and observations the above allegation(s) above is unsubstantiated at this time.

Regarding the allegation: Staff inappropriately locked resident’s sliding door. It is being alleged that the RP stated there is no window and the sliding door was locked. LPA was able to observe the room in which Resident #1(R1) resides, and the sliding door was open at the time. LPA took a picture of the sliding door being open. In addition, the LPA tested the sliding doors to see if there was any malfunction and there was none, the door could be opened by pulling on it. Six (6) out of eight (8) residents were able to confirm that they can open their sliding door. Four (4) out of four (4) staff confirmed that the sliding doors do open, but you must physically open it. Therefore, based on the LPA's interviews and observations the above allegation(s) above is unsubstantiated at this time.

Regarding the allegation: Staff do not meet a resident’s hygiene needs. It is being alleged that the RP stated they have asked the staff/above facility about a haircut for Resident #1(R1) because they choke on their hair when they eat. LPA was able to observe R1 in their room and R1 had a haircut. LPA also when speaking to RP asked them to send the picture in which they show R1’s hair was not cut. RP sent the picture, and the picture was back-dated April of 2023. LPA obtained the new picture of R1 showing them with a haircut. Six (6) out of eight (8) residents were able to confirm that their hygiene needs are met. Four (4) out of four (4) staff confirmed that they do provide haircuts, extra showers to residents if time permits and other grooming services if there is enough staff and enough time. Therefore, based on the LPA's interviews and observations the above allegation(s) above is unsubstantiated at this time.

LIC 9099C-continued

SUPERVISOR'S NAME: Troy AgardTELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Gina SaucedoTELEPHONE: (818) 304-3057
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 31-AS-20240201103107
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: 03/26/2024
NARRATIVE
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Regarding the allegation: Staff do not ensure resident to be properly fed while in care. It is being alleged that the RP said Resident #1(R1) did not eat for 2-3 days, only the ensure that the RP had to beg for. LPA was able to observe R1 in their room while in hospice care with a terminally illness. There were plenty of ensure and water bottles in the room. R1 was asked by the Med-tech supervisor if they wanted to eat anything which would be taken to their room from the kitchen area and R1 responded, “no” in front of the LPA. The Med-tech supervisor was also able to show the LPA a video where R1 was eating outside of the facility patio with family members that came to visit R1 a week prior to LPA coming to the above facility. In the video, R1 was observed eating a burrito. LPA was also able to obtain a picture of R1 eating in the dining hall of the above facility. Six (6) out of eight (8) residents were able to confirm that their food is good, and some residents stated they can buy outside food. Four (4) out of four (4) staff confirmed that proper meals are provided, and residents can also leave the above facility and buy their own food. Therefore, based on the LPA's interviews and observations the above allegation(s) above is unsubstantiated at this time.

Regarding the allegation: Staff do not properly maintain the facility grounds. It is being alleged that the place is dirty. During LPA’s physical plant tour, LPA did not find the above facility grounds to be dirty. LPA observed housekeeping staff cleaning resident rooms and the common facility areas. LPA was able to observe both rooms that Resident #1(R1) resided in, both in good condition and free of debris. R1 resided in room 120 and 107 of the facility. Four (4) out four (4) staff confirmed that R1 was transferred from room 120 a shared room to 107 to have a private room while in hospice care at the facility. R1 was housed in room 107 single, occupied for no additional charge because of their terminal illness and hospice care so they can be comfortable and free of distractions. Six (6) out of eight (8) residents were able to confirm that the above facility is clean. Therefore, based on the LPA's interviews and observations the above allegation(s) above is unsubstantiated at this time.

An exit interview was conducted, no citations were issued for the above allegation(s), and a copy of this report was given to the administrator.

SUPERVISOR'S NAME: Troy AgardTELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Gina SaucedoTELEPHONE: (818) 304-3057
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4