197606902-4-24-2024-31-AS-NMAN-D6EUFS-20240620153312

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606902
Report Date: 04/24/2024
Date Signed: 04/24/2024 04:12:14 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
04/19/2024 and conducted by Evaluator Abeye Duguma

COMPLAINT CONTROL NUMBER: 31-AS-20240419155825

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: 81	DATE:	04/24/2024
		UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Charles Arrieta, Executive Director		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Staff leaves resident soiled for an extended period of time.
Staff does not answer resident's call button in a timely manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced initial complaint visit to the facility to investigate the above allegation. LPA met with Administrator, Charles Arrieta, and explained the reason for the visit.

--- Staff leaves resident soiled for an extended period of time.

It was alleged that resident is being left in dirty diaper for up to five (05) hours. To investigate the allegation, on 04/24/2024 LPA conducted a physical plant tour at around 10:45 AM, interviewed four (04) staff from 11:45 AM – 12:45 PM and interviewed eight (08) residents from 12:45 PM – 2:45 PM. During the physical plant tour and resident interviews, LPA did not experience any malodor and observed that all residents were clean and well groomed.

(CONT. LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 04/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2024

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-20240419155825

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: 04/24/2024

NARRATIVE

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During interviews with staff, all staff stated incontinent resident are checked on every two hours for changing and changed at least four times a day regardless of need. During interviews with residents, one (01) out of eight (08) residents stated they are left soiled for an extended time. All other resident stated they are changed often and are not left soiled for an extended time.

Based on interviews and observations, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

--- Staff does not answer resident's call button in a timely manner.

It was alleged that resident is not being attended to timely. To investigate the allegation, on 04/24/2024 LPA conducted a physical plant tour at around 10:45 AM, interviewed four (04) staff from 11:45 AM – 12:45 PM and interviewed eight (08) residents from 12:45 PM – 2: 45 PM. During the physical plant tour and resident interviews, LPA selected three (03) rooms at random and pressed the call button. LPA observed an average response time of three (03) minutes to the call button. During interviews with staff, all staff stated they respond to the call button within one (01) to three (03) minutes. During interviews with residents, one (01) out of eight (08) residents stated staff takes between ten (10) to twenty (20) minutes to respond to the call button. All other resident stated staff respond within five (05) to ten (10) minutes.

Based on interviews and observations, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

No health and safety hazards noted during the visit.

Exit interview conducted and a copy of the report was issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 04/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2024

LIC9099 (FAS) - (06/04)

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