197606902-8-28-2024-31-AS-TAGD-D9DP2C-20240923105542

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606902
Report Date: 08/28/2024
Date Signed: 08/28/2024 01:26:00 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
07/19/2023 and conducted by Evaluator Gina Saucedo

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20230719132921

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: 87	DATE:	08/28/2024
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Charles Arrieta, Administrator		TIME COMPLETED:	01:25 PM

ALLEGATION(S):

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Illegal eviction
Staff handled resident in a rough manner
Staff spoke inappropriately to resident
Staff yelled at resident

INVESTIGATION FINDINGS:

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On 08/28/24, at 9:20am, 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 explained the purpose of this visit was to gather additional information and deliver findings for this complaint.

On 07/25/2023, Licensing Program Analyst (LPA) Melissa Spaeth initiated the complaint investigation. On 08/28/24, LPA Saucedo asked for the census, staff, and resident rosters. On 08/28/24, LPA Saucedo interviewed additional staff and residents, conducted a physical tour, gathered additional information, and delivered findings.

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: 08/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024

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-20230719132921

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: 08/28/2024

NARRATIVE

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Regarding the allegation: Illegal eviction. It is being alleged that the resident has been served a wrongful eviction notice. The eviction notice was provided on July 12, 2023, stated the reason of eviction, and was sent to CCLD-Community Care Licensing Department. Even though this eviction notice was provided, Resident #1 (R1) continued to reside at the above facility until June 20, 2024. R1 was previously interviewed by LPA Saucedo on 02/14/24 regarding another eviction notice that was reissued. R1 stated to LPA Saucedo, “that drinking was abolished in 1933 and that was their right.” Furthermore, R1 signed an admission agreement that says no illegal drug is permitted in the premises on August of 2016. On 11/12/2016, R1 received their first letter from the above facility stating that this was their final warning regarding the alcohol policy and bringing alcohol into the facility. During their stay at the above facility, R1 received several warnings and CCLD received several Unusual/Incident/Injury Reports stating R1’s alcohol use on the premises, harassing and being aggressive to other residents, and other negative behaviors documented. LPA Saucedo collected all documentation regarding the reason for the eviction. Seven (7) out eight (8) residents confirmed that they have not had an Illegal eviction notice given to them. Three (3) out of three (3) staff confirmed that eviction notices are only given to residents for not paying rent and mostly history of bad behavior that affects both staff and residents. Therefore, based on the LPA's records review, staff and resident interviews, the above allegation(s) above is UNSUBSTANTIATED at this time.

Regarding the allegation: Staff handled resident in a rough manner. It is being alleged that one (1) of the staff handled the resident Inappropriate manner out of the dining hall. Seven (7) out of Eight (8) residents confirmed that they have not been handled in a rough manner or witnessed any resident handled in a rough manner by staff. Three (3) out of three (3) staff confirmed that they have never handled a resident in a rough manner, and it would never be allowed. At the time of the visit, LPA did not observe any staff handling any resident in a rough manner. Therefore, based on the LPA's observations, staff and resident interviews, the above allegation(s) above is UNSUBSTANTIATED at this time.

Regarding the allegation: Staff spoke inappropriately to resident. It is being alleged that the staff used offensive language towards the resident. Seven (7) out of Eight (8) residents confirmed that they have never been spoken to in an inappropriate manner. Three (3) out of three (3) staff confirmed that speaking to anyone inappropriately including residents is unacceptable. At the time of the visit, LPA did not observe any staff speaking inappropriately to any of the residents. Therefore, based on the LPA's observations, staff and resident interviews, the above allegation(s) above is UNSUBSTANTIATED at this time.

LIC 9099C-continued

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Gina Saucedo	TELEPHONE: (818) 304-3057
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20230719132921

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: 08/28/2024

NARRATIVE

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Regarding the allegation: Staff yelled at resident. It is being alleged that the staff yell at the residents. Seven (7) out of Eight (8) residents confirmed that they have never been yelled at by a staff. Three (3) out of three (3) staff confirmed that yelling at anybody will not be allowed. At the time of the visit, LPA did not observe any staff yelling at any of the residents. Therefore, based on the LPA's observations, staff and resident interviews, the above allegation(s) above is UNSUBSTANTIATED at this time.

An exit interview was conducted, no citation(s) were issued for the 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: 08/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024

LIC9099 (FAS) - (06/04)

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