197606902-1-3-2024-31-AS-TAGD-CZMUBX-20240119142703

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606902
Report Date: 01/03/2024
Date Signed: 01/03/2024 12:50:49 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
12/15/2023 and conducted by Evaluator Gina Saucedo

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20231215150425

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: 83	DATE:	01/03/2024
		UNANNOUNCED	TIME BEGAN:	12:10 PM
MET WITH:	Rolly Ongkiko		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Facility staff are not seeking resident medical attention.

INVESTIGATION FINDINGS:

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On 01/03/24, at 12:10pm, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, subsequent complaint visit and was greeted by the assistant administrator-Rolly Ongkiko. LPA asked for the census, staff, and resident files.

Regarding the allegation: Facility staff are not seeking resident medical attention. It is being alleged that the resident (R1) has fungus on tongue that is not being addressed, and the resident has been asking for the last two months and no one is providing assistance. LPA conducted a physical plant tour of the facility at 12:15 p.m. and interviewed additional staff and residents. There are no reports of residents not receiving medical attention. In addition, there is additional documentation from staff supporting that there has been several appointments made for R1 that have been cancelled and missed by R1. Based on the LPA's interviews, observations, and record reviews the above allegation(s) will be unsubstantiated at this time. An exit interview was conducted no citation(s) were issued and a copy of this report was given to the assistant administrator.

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: 01/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024

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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