197606902-1-24-2024-31-AS-MVAO-D292PU-20240207163456

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606902
Report Date: 01/24/2024
Date Signed: 01/24/2024 12:18:18 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
01/16/2024 and conducted by Evaluator Gina Saucedo

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20240116114749

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: 85	DATE:	01/24/2024
		UNANNOUNCED	TIME BEGAN:	09:44 AM
MET WITH:	Charles Arrieta		TIME COMPLETED:	12:35 PM

ALLEGATION(S):

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Facility staff did not safegurard resident's personal belongings.

INVESTIGATION FINDINGS:

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On 01/24/24, Licensing Program Analyst (LPA) Gina Saucedo conducted a subsequent, complaint visit at the above facility to address the following allegation(s). LPA Gina Saucedo was met by Administrator Charles Arrieta. LPA explained the purpose of this visit was to gather more information, interviews and deliver findings for this complaint.

The investigation consisted of the following: On 01/17/2024, LPA Saucedo initiated a complaint investigation and requested documents regarding the allegation(s). On 01/17/24, LPA Saucedo also conducted staff interviews. On 01/24/24, LPA Saucedo asked for the census, requested the staff and resident roster. At 9:45am, LPA toured the physical plant, conducted additional staff and resident interviews.

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: 01/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

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-20240116114749

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: 01/24/2024

NARRATIVE

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Regarding the allegation: Facility staff did not safeguard resident's personal belongings. It’s being alleged that R1 contacted the facility to inquire about their personal belongings and the facility no longer has them.

According to the resident and staff interviews personal belongings are the resident's responsibility. LPA was also able to obtain R1's admission agreement that R1 signed on 06/2022 and the admission agreement also states under belongings removal that the facility will make reasonable efforts to assist resident and/or responsible person with belongings removal. If not removed further charges may apply, prorated by a daily rate but not less than $100 per day. LPA also obtained R1's Record of Client/Resident's Safeguarded Cash Resources which shows R1 had no money, and therefore, belongings were not able to be kept at the facility. During one of the Veteran Affairs staff interviews, the staff disclosed that R1 told them while staying in the hospital to donate the rest of their belongings to the Veteran Affairs Department. Based on LPA's staff and resident interviews, and LPA record's reviews the allegation(s) above is unsubstantiated at this time.

An exit interview was conducted, no citations were issued for 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: 01/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

LIC9099 (FAS) - (06/04)

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