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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197606902
Report Date: 10/31/2022
Date Signed: 10/31/2022 12:14:51 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
10/21/2022 and conducted by Evaluator Joscelyn Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20221021102352
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: 77DATE:
10/31/2022
UNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Charles Arrieta TIME COMPLETED:
12:20 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff opened residents mail.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 10/31/22 Licensing Program Analyst (LPA) Joscelyn Martinez arrived at the facility to conduct a subsequent complaint investigation visit. Initial visit was conducted on 10/25/22. Upon arrival LPA met with administrator and the purpose of the visit was explained.

Allegation: Staff opened residents mail.
It is alleged that staff are opening residents mail. To investigate this allegation LPA conducted interviews on 10/25/22 and on 10/31/22. LPA also collected relevant documents. Three (3) out of three (3) staff interviewed stated they do not open resident's mail. Once the mail is received at the facility, designated staff, S2 or S3, will sort and distribute the mail accordingly. This includes hand delivering the mail or putting the mail in resident's locked mail boxes located in the front lobby of the facility. Interviews with ten (10) out of eleven (11) residents revealed when they receive their mail it is unopened and they have never received mail that is opened by the staff. Based on interviews conducted, this allegation is deemed Unsubstantiated at this time.

Exit interview conducted. Report signed and delivered. Appeal rights delivered.
Unsubstantiated
Estimated Days of Completion: a
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Joscelyn MartinezTELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2022
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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