197606902-7-8-2025-31-AS-TAGD-DKCSLN-20250808135838

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606902
Report Date: 07/08/2025
Date Signed: 07/08/2025 01:50:01 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
06/25/2025 and conducted by Evaluator Gina Saucedo

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20250625182731

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:	07/08/2025
		UNANNOUNCED	TIME BEGAN:	11:23 AM
MET WITH:	Charles Arrieta, Administrator		TIME COMPLETED:	02:05 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff changed resident's doctor without resident consent

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 07/08/25, at 11:23am, 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, interview staff and residents and deliver findings for this complaint.

On 06/30/25, LPA Saucedo conducted the initial visit and asked for the census, staff, and resident rosters. On 06/30/25, LPA Saucedo conducted a physical tour, interviewed staff and residents. On 07/08/25, LPA Saucedo conducted another physical tour, interviewed additional staff and additional residents.

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: 07/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2025

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 2

Control Number 31-AS-20250625182731

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: 07/08/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Regarding the allegation: Staff changed resident's doctor without resident consent. It is being alleged that because of the changes, the resident cannot contact their previous doctor, new doctor and/or get medication changed. LPA interviewed five (5) staff that confirmed they have not changed any resident’s doctor and/or medical insurance. LPA also interviewed eight (8) residents that confirmed they did not have any changes to their doctor and/or medical insurance by any staff. One (1) residents-resident #2 (R2) did confirm they have changed their medical insurance recently, but it was due to them not being happy with their prior insurance. LPA asked R2 if staff helped them make this change and R2 stated, “no, I made the changes myself.” 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: 07/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 2