197606902-4-17-2024-31-AS-NMAN-D4TQB9-20240430120111

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606902
Report Date: 04/17/2024
Date Signed: 04/17/2024 02:48:25 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.ASC, 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
04/11/2024 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20240411115312

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: 84	DATE:	04/17/2024
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Charles Arrieta		TIME COMPLETED:	02:50 PM

ALLEGATION(S):

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Staff did not ensure resident's a/c was not in disrepair

INVESTIGATION FINDINGS:

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At 9:15 a.m. on 04/17/2024 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with the administrator and disclosed the reason for the visit.

Regarding the allegation “Staff did not ensure resident's a/c was not in disrepair”, it was alleged the cooling unit for the room of Resident #1 (R1) did not sufficiently cool the room. To investigate the allegation, LPA interviewed the administrator at 9:30 a.m. today, reviewed pertinent records at 9:45 a.m. including but not limited to the resident list, staff list, admission agreement, medical assessment, preplacement appraisal, care plan, and physician’s orders, interviewed R1 at 10:15 a.m., a family member (F1) at 11:00 a.m., Staff #1 (S1) at 11:30 a.m., and toured the facility at 2:15 p.m.

Record review revealed R1 has a heart condition. R1’s physician’s order advised against “extreme heat”. R1’s preplacement appraisal noted R1 was “heat and sound sensitive”. Interview with the administrator revealed new air conditioning units were installed about ten (10) years ago.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 04/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2024

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-20240411115312

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: OLIVE BRANCH ASSISTED LIVING, THE	FACILITY NUMBER: 197606902
	VISIT DATE: 04/17/2024

NARRATIVE

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Each air conditioning unit serves four (04) rooms, and all are in working order. Interview with F1 revealed the air conditioning unit works, but the room needs to be cooler for R1’s condition. Interview with R1 revealed they get hot easily and they were hot at the time of the interview. LPA measured the room temperature in R1’s room to be seventy-one (71) degrees Fahrenheit at approximately 10:30 a.m. today. At 2:30 p.m., LPA measured the temperatures of three (03) other rooms under the same air condition unit to be seventy-five (75), seventy-nine (79), and seventy-nine (79) degrees Fahrenheit. Based on interviews, record review, and observations, the facility air conditioning unit was working and maintained resident rooms to temperatures within regulations. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

No immediate health and safety risks were observed during this visit.

Exit interview conducted. Appeal rights discussed. Copy of report provided.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 04/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2024

LIC9099 (FAS) - (06/04)

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