The Olive Branch Assisted Living

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Allegation investigated: Staff cut resident's hair without permission.

On 7/23/26 Licensing Program Analyst (LPA) Perchui Milena Khurshudyan conducted an initial 10-day complaint visit to investigate the above allegation. Upon arrival, LPA met with the Administrator Charles Arrieta and explained the reason for the visit. During the course of investigation, LPA requested staff and residents’ rosters. At approximately 12:05pm, LPA conducted physical plant tour throughout the facility to ensure health and safety of the residents are protected. No health and safety hazards noted during the visit. At 12:10pm LPA requested copies of Admission Agreement, Appraisal Needs and Services, Physician Report, copy of Incident Report, and reviewed other pertinent documents relevant to the investigation. During the investigation, LPA conducted interviews with the Administrator, four (4) Staff, and nine (9) out of eighty (80) residents, reviewed resident records, and made observations. Continue on LIC9099-C Unsubstantiated Allegation: Staff cut resident's hair without permission. To investigate the allegation, LPA Khurshudyan conducted interview with the Administrator who denied ever cutting any residents hair without permission. Staff interviewed consistently stated that residents maintain the right to decide whether they wish to receive hair grooming services and denied witnessing any staff member provide a haircut to any resident without consent. Staff furthermore added, that residents who wish to have hair cut, go to Medication station and write their names down on the list. Later the office schedules a hair cut/grooming service for residents. LPA interviewed residents residing in the facility. Residents denied ever having hair cut against their wishes and stated that no staff member has forced or provided unwanted haircut to residents. LPA reviewed Resident 1 (R1’s) facility records and did not find documentation indicating that hair services had been provided or that R1 had a contract or agreement with a third party hair service provider. Based on interviews conducted, records reviewed, and LPA observations, there was insufficient evidence to support the allegation. Therefore, the allegation is Unsubstantiated at this time. Exit interview conducted, and a copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Jul 23, 2026 · control 31-AS-20260714144033

Type of visit: Required - 1 Year

On 5/22/2026, Licensing Program Analyst (LPA) Perchui Milena Khurshudyan arrived at this facility to conduct a required Annual Inspection. Upon arrival LPA introduced herself by showing her department badge, was greeted by the Chief Executive Officer (CEO) Charles Arrieta and the Assistant Administrator (AA) Rolando Ongkiko. LPA explained the reason for the visit and requested staff and residents’ rosters for review. LPA Khurshudyan reviewed the required postings on a wall and used the inspection tool to complete today's visit. The YES sign, Ombudsman information, Personal Rights, Disaster Plan, Master Menu, and Activity schedules are displayed along the hallway leading to the first-floor dining area. A tour of the physical plant was conducted at around 10:50am and the following was noted: The facility is fire cleared for one hundred forty-six (146) Non-ambulatory residents. The facility also has a hospice waiver for three (3) residents. The facility is currently occupying eighty-one (81) residents. There is one main entrance being utilized at the facility. The facility is two-story building and has one (1) elevator. During the visit, LPA checked the elevator and observed it was operating properly. The facility has a total of seventy-three (73) beds, of which forty-three are on the second floor and thirty (30) on the first floor. The facility has private and shared rooms for residents. LPA observed several common bathrooms throughout the facility, all bathrooms appeared clean and were functional. Bathrooms had signs, grab bars and paper towels. The staff and resident bathrooms are not shared. Adjacent to the laundry room accessible from the facility is a shower area available for residents who cannot shower independently or require a larger space, such as those who use wheelchairs. Continue on LIC809-C The kitchen is sufficiently stocked with at least two (02) days perishable and seven (07) days of non-perishable food. LPA observed a walk-in refrigerator and freezer stocked with adequate amount of frozen and fresh foods wrapped and stored appropriately. Food storage and preparation areas were clean and inaccessible to pests. Knives and sharps are observed on the counter-top, under supervision, and inaccessible to residents. A dietitian visits the facility every month. The daily menus were posted and available in the dining area. A restricted diet menu was also available for residents requiring special diets. The kitchen closes at 6:00pm and reopens at 6:00am. The common areas and dining room appeared neat and clean. The activity room and TV room were nicely furnished. The monthly activity schedule was posted and available for residents. The facility also has library and a hair salon. All common areas were observed to be cleaned and properly furnished. The library has seating for residents and has books in several shelves on the second floor. The activity room has a large television and has enough seating for several residents to watch the television and do different activities on the second floor. The facility maintains a comfortable temperature at 69°F-79°F. The smoke and carbon monoxide detectors are hardwired, interconnected and centralized with automatic dispatch to the Los Angeles Fire Department. Last fire inspection was done on 4/27/2026. Fire extinguishers were located throughout the facility and observed to be fully charged and last inspected on 10/23/2025. LPA observed at least seven (7) fire extinguishers throughout the facility. There is also fire sprinklers located throughout the facility upstairs and downstairs. LPA toured a random selection of resident rooms. All bedrooms were properly furnished and had appropriate bedding, linens and a lighting system. The call signal system was tested and functioned properly. Hallways were odorless and free of obstructions. Residents have enough personal hygiene products. The bathrooms were checked for cleanliness and proper operations. Towels and washcloths are not shared. There was enough clean linen available in each resident room. Hot water temperature measured between 107.3 and 117.2 degrees Fahrenheit. There is a separate Medication Room on the first floor. LPA observed properly labeled medications and residents’ medical files to be locked and inaccessible to residents in care. The facility maintains a complete first aid kit. There are two (2) Med-techs / staff on duty during the daytime. Syringes for residents are stored in a red refrigerator, and residents self-administer their prescribed dosages. Diabetic and blood pressure readings are maintained in a binder, and the centrally stored medication destruction records are kept in a cabinet. Continue on LIC-809C The facility has two (2) laundry rooms. The Laundry rooms observed to be locked. One laundry area is located outside and contains large washers and dryers, all cleaning supplies, chemicals and detergents are stored inside locked closets and inaccessible to residents. This area also stores extra linen. A second laundry area is located inside the facility and can be accessed with a key. The facility has nice outdoor furniture with a covered shaded area for residents and visitors. The facility does not have a swimming pool/body of water. All pathways are clear of obstruction. Between 12:35pm -2pm LPA conducted records review of ten (10) staff files and eight residents’ records. Files were complete and updated. LPA collected LIC500, LIC9020, Copy of Administrator Certificate, and Copy of Liability Insurance. No health and safety hazards noted during today’s visit. No citations issued during today's visit. Exit interview conducted. Copy of this report provided.the state’s words, verbatim · CDSS document, May 22, 2026

Allegation investigated: Staff changed resident's doctor without resident consent

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 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.the state’s words, verbatim · CDSS document, Jul 8, 2025 · control 31-AS-20250625182731

Type of visit: Required - 1 Year

On 05/20/25 at 9:20 AM, Licensing Program Analyst (LPA) Gina Saucedo, arrived to conduct an unannounced, annual inspection at the facility. Upon arrival, LPA Saucedo met with Administrator, Charles Arrieta and disclosed the purpose of the visit. LPA asked for the census, resident, and staff files. A physical tour was conducted at 10:30AM and observed the following: The entire facility has at total of 73(seventy-three) beds. Forty-three (43) on the second floor and thirty (30) on the first floor. The physical tour started on the first floor. Random Bedrooms were randomly selected to tour and were observed to have appropriate furniture, lightening, bedding and televisions. Some of the bedrooms had their own small refrigerators, utensils. Random Bathrooms were observed to have grab bars and non-skid mats. Hot water temperature was tested randomly for and measured 118–119-degree Fahrenheit. Fire extinguishers were observed throughout the facility and were fully charged on green with different dates such as October 2025 and May 2025. There are fire extinguishers upstairs, downstairs and in the kitchen area. Carbon Monoxide and fire alarms are located throughout the facility and are operable. There are also fire sprinklers located throughout the facility upstairs and downstairs. 809C-continued Facility has a designated medication room that is inaccessible to residents where all the medication is stored and locked. There are two (2) medical-technician staff during the daytime. The syringes for residents are kept in a refrigerator and the residents are provided with the dosage but they administer it themselves. The diabetic and high blood pressure results are kept in a binder. The centrally stored medication destruction record is sheet is kept in a cabinet. The outside/backyard/patio area was accessible to residents with different areas for them to sit. There is appropriate outdoor furniture for the residents to sit on with proper shading. There is no body of water. Common Areas: These include the dining areas, library, hair salon, and activities room. All common areas were observed to be cleaned and properly furnished. The library has sitting for residents and has books in several shelves on the second floor. The activity room has a large television and has enough seating for several residents to watch the television and do different activities on the second floor. The dining area has the menu against the wall. Facility maintains a comfortable temperature of 75, 76, 80, 81-degree Fahrenheit. There are several temperature thermostats throughout the facility. There are several common bathrooms throughout the upstairs and downstairs area. The staff and resident bathrooms are not shared. There are several separate bathrooms for residents and staff throughout the facility. There are trash cans with lids and covid signs posted in the common bathrooms. There is toilet paper and napkins. There is one (1) egress chair located in the facility office. There are two (2) facility laundry areas. One (1) is located outside and has large washers and dryers with locked chemicals inaccessible to the residents. This laundry area has extra linen, and one (1) is located inside that can be entered from the facility with a key. Next to the laundry room that is accessible from the facility is a shower area that residents can use if they cannot shower themselves or need a larger area to shower for example residents with wheelchairs. 809C-continued The Kitchen area was toured, and LPA observed there to be sufficient seven (7) day supply of non-perishable foods and perishable food for all residents. The kitchen area was clean at the time of the tour. The dining area is located next to the kitchen where different residents were having lunch with proper feeding utensils/plates/cups. Next to the kitchen/dining room area is a vending machine for residents and staff use that has snacks. There is fire extinguisher and fire sprinklers in the kitchen area. Administrative: The Insurance plan is dated as of 09/07/2025. There is a disaster plan manual located in the office of the facility where the staff and resident files are located. The last disaster and fire drill was conducted on 4/28/25, 03/22/25, 02/23/25 and 01/25/25. There is a company that is named SouthWest contracted by the facility to do fire drills. The YES sign, Ombudsman, Personal Rights, Disaster Plan, Master Menu and Activities are located down the hallway leading to the dining area on the first floor An exit interview was conducted, no citation(s) were issued, and a copy of this report was given to the administrator.the state’s words, verbatim · CDSS document, May 20, 2025

Allegation investigated: Facility is unlawfully evicting resident

On 01/21/25, at 9:40am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, initial complaint visit and was greeted by Administrator Charles Arrieta. LPA explained the purpose of this visit was to gather information, interview staff and residents and deliver findings for this complaint. On 01/21/25, LPA Saucedo asked for the census, staff, and resident rosters. On 01/21/25, LPA Saucedo conducted a physical tour and interviewed staff and residents. LIC 9099C-continued Unsubstantiated Regarding the allegation: Facility is unlawfully evicting resident. It is being alleged that resident #1 (R1) has refused to take prescribed medication and has endangered himself and others. A thirty (30) day eviction notice was provided to the resident on 01/13/25 and was sent to CCLD-Community Care Licensing Department on 01/14/25. On 01/13/25, R1 became aggressive with their roommate and a staff member, 911 and R1’s Veteran Affair’s Case Manager were called. R1 was then taken to the hospital and placed on a 51/50 hold. On 12/16/24, CCLD received an Unusual/Incident/Injury Report regarding R1 coming into the staff office and becoming aggressive with the business manager by pulling the facility resident financial records book from their hands. On 12/17/24, R1 received a final warning regarding their aggressive behavior; and thus, house rules being violated. The resident appraisal was updated on 12/25/24 regarding R1. Seven (7) out eight (8) residents confirmed that they have not had an unlawful eviction notice given to them. During resident interviews, two (2) residents confirmed that R1 was aggressive with them. Four (4) staff confirmed that R1 was aggressive with them. LPA obtained R1’s Admission Agreement which states verbal, or physical abuse directed towards other residents or staff is grounds for eviction and harming or threatening to harm oneself and others. Therefore, based on the LPA's records review, 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.the state’s words, verbatim · CDSS document, Jan 21, 2025 · control 31-AS-20250116163655

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

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 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 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.the state’s words, verbatim · CDSS document, Aug 28, 2024 · control 31-AS-20230719132921

Type of visit: Required - 1 Year

On 05/28/24 at 10:05 AM, Licensing Program Analyst (LPA) Gina Saucedo, arrived to conduct an unannounced, annual inspection at the facility. Upon arrival, LPA Saucedo met with Administrator, Charles Arrieta and disclosed the purpose of the visit. LPA asked for the census, resident, and staff files. A physical tour was conducted at 11:50 AM and observed the following: The entire facility has at total of 73(seventy-three) beds. Forty-three (43) on the second floor and thirty (30) on the first floor. The physical tour started on the first floor. Random Bedrooms were randomly selected to tour and were observed to have appropriate furniture, lightening, bedding and televisions. Some of the bedrooms had their own small refrigerators, utensils. Random Bathrooms were observed to have grab bars and non-skid mats. Hot water temperature was tested randomly for and measured 115–119-degree Fahrenheit. Fire extinguishers were observed throughout the facility and were fully charged on green with different dates. There are fire extinguishers upstairs, downstairs and in the kitchen area. Carbon Monoxide and fire alarms are located throughout the facility and are operable. Facility has a designated medication room that is inaccessible to residents where all the medication is stored and locked. There are two (2) med-tech staff during the daytime. The outside/backyard is accessible to residents with different areas for them to sit. There is appropriate outdoor furniture for the residents to sit on with proper shading. There is no body of water. 809C-continued Common Areas: These include the dining areas, library, hair salon, and activities room. All common areas were observed to be cleaned and properly furnished. The library has sitting for residents and has books in several shelves. The activity room has a large television and has enough seating for several residents to watch the television and do different activities. Facility maintains a comfortable temperature of 75.-76-degree Fahrenheit. There are several temperature thermostats throughout the facility. There are several common bathrooms throughout the upstairs and downstairs area. The staff and resident bathrooms are not shared. There are trash cans with lids and covid signs posted in the common bathrooms. There is toilet paper and napkins. There are two (2) facility laundry areas. One (1) is located outside and has large washers and dryers with locked chemicals inaccessible to the residents. This laundry area has extra linen, and one (1) is located inside that can be entered from the facility with a key. Next to the laundry room that is accessible from the facility is a shower area that residents can use if they cannot shower themselves or need a larger area to shower for example residents with wheelchairs. The Kitchen area was toured, and LPA observed there to be sufficient seven (7) day supply of non-perishable foods and perishable food for all residents. The kitchen area was clean at the time of the tour. The dining area is located next to the kitchen where different residents were having lunch with proper feeding utensils/plates/cups. Next to the kitchen/dining room area is a vending machine for residents and staff use. Administrative: There is no annual fee that is due right now. The Insurance plan is dated as of 09/2023. There is a disaster plan manual located in the office of the facility where the staff and resident files are located. The last disaster and fire drill was conducted on 5-23-2024. The YES sign, Ombudsman, Personal Rights, Disaster Plan, Master Menu and Activities are located down the hallway leading to the dining area. An exit interview was conducted, no citations were issued, and a copy of this report was given to the administrator.the state’s words, verbatim · CDSS document, May 28, 2024

Allegation investigated: Staff leaves resident soiled for an extended period of time. Staff does not answer resident's call button in a timely manner.

Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced initial complaint visit to the facility to investigate the above allegation. LPA met with Administrator, Charles Arrieta, and explained the reason for the visit. --- Staff leaves resident soiled for an extended period of time. It was alleged that resident is being left in dirty diaper for up to five (05) hours. To investigate the allegation, on 04/24/2024 LPA conducted a physical plant tour at around 10:45 AM, interviewed four (04) staff from 11:45 AM – 12:45 PM and interviewed eight (08) residents from 12:45 PM – 2:45 PM. During the physical plant tour and resident interviews, LPA did not experience any malodor and observed that all residents were clean and well groomed. (CONT. LIC9099-C) Unsubstantiated During interviews with staff, all staff stated incontinent resident are checked on every two hours for changing and changed at least four times a day regardless of need. During interviews with residents, one (01) out of eight (08) residents stated they are left soiled for an extended time. All other resident stated they are changed often and are not left soiled for an extended time. Based on interviews and observations, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. --- Staff does not answer resident's call button in a timely manner. It was alleged that resident is not being attended to timely. To investigate the allegation, on 04/24/2024 LPA conducted a physical plant tour at around 10:45 AM, interviewed four (04) staff from 11:45 AM – 12:45 PM and interviewed eight (08) residents from 12:45 PM – 2: 45 PM. During the physical plant tour and resident interviews, LPA selected three (03) rooms at random and pressed the call button. LPA observed an average response time of three (03) minutes to the call button. During interviews with staff, all staff stated they respond to the call button within one (01) to three (03) minutes. During interviews with residents, one (01) out of eight (08) residents stated staff takes between ten (10) to twenty (20) minutes to respond to the call button. All other resident stated staff respond within five (05) to ten (10) minutes. Based on interviews and observations, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. No health and safety hazards noted during the visit. Exit interview conducted and a copy of the report was issued.the state’s words, verbatim · CDSS document, Apr 24, 2024 · control 31-AS-20240419155825

Allegation investigated: Staff did not ensure resident's a/c was not in disrepair

At 9:15 a.m. on 04/17/2024 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with the administrator and disclosed the reason for the visit. Regarding the allegation “Staff did not ensure resident's a/c was not in disrepair”, it was alleged the cooling unit for the room of Resident #1 (R1) did not sufficiently cool the room. To investigate the allegation, LPA interviewed the administrator at 9:30 a.m. today, reviewed pertinent records at 9:45 a.m. including but not limited to the resident list, staff list, admission agreement, medical assessment, preplacement appraisal, care plan, and physician’s orders, interviewed R1 at 10:15 a.m., a family member (F1) at 11:00 a.m., Staff #1 (S1) at 11:30 a.m., and toured the facility at 2:15 p.m. Record review revealed R1 has a heart condition. R1’s physician’s order advised against “extreme heat”. R1’s preplacement appraisal noted R1 was “heat and sound sensitive”. Interview with the administrator revealed new air conditioning units were installed about ten (10) years ago. Unsubstantiated Each air conditioning unit serves four (04) rooms, and all are in working order. Interview with F1 revealed the air conditioning unit works, but the room needs to be cooler for R1’s condition. Interview with R1 revealed they get hot easily and they were hot at the time of the interview. LPA measured the room temperature in R1’s room to be seventy-one (71) degrees Fahrenheit at approximately 10:30 a.m. today. At 2:30 p.m., LPA measured the temperatures of three (03) other rooms under the same air condition unit to be seventy-five (75), seventy-nine (79), and seventy-nine (79) degrees Fahrenheit. Based on interviews, record review, and observations, the facility air conditioning unit was working and maintained resident rooms to temperatures within regulations. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. No immediate health and safety risks were observed during this visit. Exit interview conducted. Appeal rights discussed. Copy of report provided.the state’s words, verbatim · CDSS document, Apr 17, 2024 · control 31-AS-20240411115312

Allegation investigated: Staff is mishandling a resident's personal funds Staff do not keep a resident's room free from odor Staff do not provide laundry services for a resident Staff do not properly maintaining a resident's bathroom Staff inappropriately locked a resident's sliding door Staff do not meet a resident's hygiene needs Staff do not ensure a resident is being properly fed while in care Staff do not properly maintain the facility grounds

On 03/26/24, at 11:35am, 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 disclosed the purpose of the visit. LPA explained the purpose of this visit was to gather additional information, conduct more interviews and deliver findings for this complaint. On 02/06/2024, LPA Saucedo initiated the complaint investigation. On 02/13/24, LPA conducted a subsequent visit to gather additional information. On 03/26/24, the investigation consisted of the following: LPA Saucedo asked for the census, requested the staff and resident roster. At 11:45am, LPA toured the physical plant. During the tour, additional interviews were conducted. LIC 9099C-continued Unsubstantiated Regarding the allegation: Staff is mishandling a resident's personal funds. It is being alleged that the resident is taken shopping weekly with their own allowance. LPA was able to review Resident #1 (R1)’s record of client/resident’s safeguard cash resources dating 2024, 2023, 2022 and 2021 where it shows the handling of R1’s personal funds. LPA was also able to review rental payments paid by the conservator. R1 as of July 18, 2017, had a conservator. The assistant administrator did state that the above facility does provide transportation to the residents if they want to go shopping for themselves and use their own funds. Six (6) out of eight (8) residents confirmed that they can go shopping if they want with their own money. Four (4) out of four (4) staff confirmed that shopping is allowed by the residents if they have money. Therefore, based on the LPA's interviews, observations and record reviews the above allegation(s) above is unsubstantiated at this time. Regarding the allegation: Staff do not keep resident’s room free from odor. It is being alleged that RP states the Resident #1(R1)’s smelled terrible. During LPA’s physical tour, LPA did not observe any odor that smelled terrible in the common areas. LPA also toured both of R1’s room the previous and the new room in which no odor that smelled terrible was observed/smelled in any of the rooms. Six (6) out of eight (8) residents were able to confirm that their room is cleaned daily. Four (4) out of four (4) staff confirmed that the rooms are cleaned daily. Therefore, based on the LPA's interviews and observations the above allegation(s) above is unsubstantiated at this time. Regarding the allegation: Staff do not provide laundry services for resident. It is being alleged that the RP stated that Resident #1(R1) rarely gets a bath and their clothes laundered. RP states they have pictures of R1 wearing the same thing for months. LPA was able to obtain two pictures that RP had originally sent and R1 had two different clothes on. LPA visited R1 twice and R1 was not wearing the same clothing. On one occasion, R1 was wearing a green jacket with a green shirt under it and the other picture showing R1 wearing a tan, long sleeve with blue jean pants. In addition, the Admission Contract states “under Laundry” that for a fee of $30.00 per month the above facility may wash a resident’s clothes. It also states that if residents are found to be unable to take care of their chores due to health or physical disabilities, the above facility will assist. Six (6) out of eight (8) residents were able to confirm that their laundry services are met. Four (4) out four (4) staff did confirm that housekeeping and hospice care service were being provided to R1 daily because of their terminal/hospice illness. Therefore, based on the LPA's interviews, observations, and record review the above allegation(s) above is unsubstantiated at this time. LIC 9099C-continued Regarding the allegation: Staff do not properly maintain resident’s bathroom. It is being alleged that RP stated there were piles of dirty diapers next to a dirty bathtub. LPA was able to observe the previous room and the new room of Resident #1(R1) and there were no dirty diapers or/and dirty bathtub. During the physical tour, LPA also observed the housekeepers and caregivers cleaning different rooms including R1’s room. Six (6) out of eight (8) residents were able to confirm that their room is cleaned by staff. Four (4) out of four (4) staff confirmed that they do clean all the rooms daily. LPA also took a picture of the bathroom not having any dirty diapers on the floor. Therefore, based on the LPA's interviews and observations the above allegation(s) above is unsubstantiated at this time. Regarding the allegation: Staff inappropriately locked resident’s sliding door. It is being alleged that the RP stated there is no window and the sliding door was locked. LPA was able to observe the room in which Resident #1(R1) resides, and the sliding door was open at the time. LPA took a picture of the sliding door being open. In addition, the LPA tested the sliding doors to see if there was any malfunction and there was none, the door could be opened by pulling on it. Six (6) out of eight (8) residents were able to confirm that they can open their sliding door. Four (4) out of four (4) staff confirmed that the sliding doors do open, but you must physically open it. Therefore, based on the LPA's interviews and observations the above allegation(s) above is unsubstantiated at this time. Regarding the allegation: Staff do not meet a resident’s hygiene needs. It is being alleged that the RP stated they have asked the staff/above facility about a haircut for Resident #1(R1) because they choke on their hair when they eat. LPA was able to observe R1 in their room and R1 had a haircut. LPA also when speaking to RP asked them to send the picture in which they show R1’s hair was not cut. RP sent the picture, and the picture was back-dated April of 2023. LPA obtained the new picture of R1 showing them with a haircut. Six (6) out of eight (8) residents were able to confirm that their hygiene needs are met. Four (4) out of four (4) staff confirmed that they do provide haircuts, extra showers to residents if time permits and other grooming services if there is enough staff and enough time. Therefore, based on the LPA's interviews and observations the above allegation(s) above is unsubstantiated at this time. LIC 9099C-continued Regarding the allegation: Staff do not ensure resident to be properly fed while in care. It is being alleged that the RP said Resident #1(R1) did not eat for 2-3 days, only the ensure that the RP had to beg for. LPA was able to observe R1 in their room while in hospice care with a terminally illness. There were plenty of ensure and water bottles in the room. R1 was asked by the Med-tech supervisor if they wanted to eat anything which would be taken to their room from the kitchen area and R1 responded, “no” in front of the LPA. The Med-tech supervisor was also able to show the LPA a video where R1 was eating outside of the facility patio with family members that came to visit R1 a week prior to LPA coming to the above facility. In the video, R1 was observed eating a burrito. LPA was also able to obtain a picture of R1 eating in the dining hall of the above facility. Six (6) out of eight (8) residents were able to confirm that their food is good, and some residents stated they can buy outside food. Four (4) out of four (4) staff confirmed that proper meals are provided, and residents can also leave the above facility and buy their own food. Therefore, based on the LPA's interviews and observations the above allegation(s) above is unsubstantiated at this time. Regarding the allegation: Staff do not properly maintain the facility grounds. It is being alleged that the place is dirty. During LPA’s physical plant tour, LPA did not find the above facility grounds to be dirty. LPA observed housekeeping staff cleaning resident rooms and the common facility areas. LPA was able to observe both rooms that Resident #1(R1) resided in, both in good condition and free of debris. R1 resided in room 120 and 107 of the facility. Four (4) out four (4) staff confirmed that R1 was transferred from room 120 a shared room to 107 to have a private room while in hospice care at the facility. R1 was housed in room 107 single, occupied for no additional charge because of their terminal illness and hospice care so they can be comfortable and free of distractions. Six (6) out of eight (8) residents were able to confirm that the above facility is clean. Therefore, based on the LPA's interviews and observations the above allegation(s) above is unsubstantiated at this time. An exit interview was conducted, no citations were issued for the above allegation(s), and a copy of this report was given to the administrator.the state’s words, verbatim · CDSS document, Mar 26, 2024 · control 31-AS-20240201103107

Allegation investigated: Facility is in disrepair.

On 02/14/24, at 12:45pm, Licensing Program Analyst (LPA) Gina Saucedo conducted an initial, complaint investigation 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 information, interviews and deliver findings for this complaint. The investigation consisted of the following: On 02/14/24, LPA Saucedo asked for the census, requested the staff and resident roster. At 1:00pm, LPA Saucedo toured the physical plant, conducted staff and resident interviews. LIC 9099C-continued Substantiated Regarding the allegation: Facility is in disrepair: It is being alleged that the elevator has been broken for over ten (10) days now. LPA was able to observe out of order sign on the elevator. LPA had to climb stairs to have access to upstairs. At 1:10pm, residents and staff were interviewed. Four (4) out of Four (4) staff interviewed confirmed that the elevator has been broken for a few days. The administrator also confirmed that the repair is taking a bit longer than expected because maintenance parts have been ordered for the repair of the elevator. In addition, eight (8) residents were interviewed and eight (8) out of eight (8) residents confirmed that the elevator has not working. Based on LPAs observations and interviews which were conducted the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. An exit interview was conducted, citation given, appeal rights, and a copy of this report was given to the administrator.the state’s words, verbatim · CDSS document, Feb 14, 2024 · control 31-AS-20240214104722

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Mar 14, 2024

87303 (a)The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Based on the LPA observation and interviews the licensee/administrator did not ensure one out of one elevator at the facility to be in repair at all times which poses a Potential Health, Safety or Personal Rights risks to persons in care.the state’s words, verbatim · CDSS document, Feb 14, 2024

Plan of correction: The licensee/admnistrator shall repair the elevator by POC due date: 03/14/24. The licensee/administrator shall send a picture/repair paperwork to the licensee.

Allegation investigated: Staff abandoned resident

On 02/06/24, at 10:15am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, initial complaint visit and was greeted by Administrator-Charles Arrieta. LPA disclosed the purpose of the visit. LPA explained the purpose of this visit was to gather information, interviews and deliver findings for this complaint. The investigation consisted of the following: LPA Saucedo asked for the census, requested the staff and resident roster. At 10:45am, LPA toured the physical plant, conducted staff interviews, obtained the following record review: Unusual Incident/Injury Report, 30-Day Eviction Notice (SB781), and Olive Branch House Rules. LIC 9099C-continued Unsubstantiated Regarding the allegation: Staff abandoned resident. It’s being alleged that RP when dropped off at West LA Medical Center was not allowed to go back to the facility. RP stated that they was never given an eviction notice and was just left at the hospital. According to the staff interviews, RP was given an eviction notice on 04-28-2023 and signed it the same day. LPA was also able to obtain RP's eviction notice which is signed by RP. The eviction notice shows that RP was given a thirty (30) day notice on March 28, 2023 by the assistant administrator. The eviction notice was given to RP because of their serious violation to the house rules of the above facility. According to staff interviews, RP's behavior became increasingly violent and caused a concern to other residents. LPA was also able to obtain the House Rules of the above facility. LPA was also able to interview the resident that RP hit and caused a concern for the care of the other residents. The resident that RP hit informed the LPA that RP threw something at them hitting them on their ear. LPA was able to obtain the Unusual Incident/Injury Report from the resident. RP was also transferred to another facility where they reside now while in the care of the West LA Medical Center and the help of the Veteran Affairs Department. Based on LPA's record reviews, staff interviews, and the interview with the resident RP hit, 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.the state’s words, verbatim · CDSS document, Feb 6, 2024 · control 31-AS-20240205141026

Allegation investigated: Facility staff did not safegurard resident's personal belongings.

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 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.the state’s words, verbatim · CDSS document, Jan 24, 2024 · control 31-AS-20240116114749

Allegation investigated: Staff are screaming at the residents Staff are mistreating a resident while in care

On 01/24/24, at 08:50 am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, initial complaint visit and was greeted by Administrator-Charles Arrieta. LPA disclosed the purpose of the visit. LPA explained the purpose of this visit was to gather information, interviews and deliver findings for this complaint. The investigation consisted of the following: 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 staff and resident interviews. LIC 9099C-continued Unsubstantiated Regarding the allegation: Staff are screaming at the residents. It’s being alleged that the screaming of staff is "shrill" and it triggers R1's PTSD. Based on the LPA record review, R1 has an Impacted cerum of bilateral ears and was diagnosed with sensorineural hearing loss. LPA's staff and resident interviews also determined that staff do not scream at the residents. Eight (8) out of eight (8) residents that were interviewed determined that they are treated well including R1. R1 admitted that they cannot hear well and their hearing aids were stolen at the last facility that they lived in. R1 has been requesting new hearing aids through the Veteran Affairs help. Staff also confirm that R1 has lost several hearing aids. LPA also observed that R1 could not hear them and had to repeat some questions several times. Based on staff and resident interviews, and LPA record's reviews the allegation(s) above is unsubstantiated at this time. Regarding the allegation: Staff are mistreating a resident while in care. It is being alleged that staff is mean to R1 and other residents. Based on the staff and resident interviews it is determined that staff are not mean to the residents. Eight (8) out of eight (8) residents confirmed that the staff treat them with respect. One resident (R2) claims, " if you do what you should be doing no one bothers you here, it is really laxed." R1, also confirmed that one of the caregivers treats him really well. The caregiver showers R1 when R1 wants to be showered and the caregiver also gives R1 haircuts. Based on LPA's staff and resident interviews, 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.the state’s words, verbatim · CDSS document, Jan 24, 2024 · control 31-AS-20240123090839

Type of visit: Required - 1 Year

On 01/13/24 at 09:35 AM, Licensing Program Analyst (LPA) Gina Saucedo, arrived to conduct an unannounced, annual inspection at the facility. Upon arrival, LPA Saucedo met with MedTech, Yolanda Lopez and disclosed the purpose of the visit. The Assistant Administrator was called and arrived at 11:25 AM Rolly Ongkiko. LPA asked for the census, resident, and staff rosters. A physical tour was conducted at 11:45 AM and observed the following: The entire facility has at total of 73(seventy-three) beds. Forty-three (43) on the second floor and thirty (30) on the first floor. The physical tour started on the second floor. Random Bedrooms were randomly selected to tour and were observed to have appropriate furniture, lightening, bedding and televisions. Some of the bedrooms had their own small refrigerators. Random Bathrooms were observed to have grab bars and non-skid mats. Hot water temperature was tested randomly for and measured 112–118-degree Fahrenheit. Fire extinguishers were observed throughout the facility and were fully charged on green with different dates. There are fire extinguishers upstairs, downstairs and in the kitchen area. Carbon Monoxide and fire alarms are located throughout the facility and are operable. Facility has a designated medication room that is inaccessible to residents where all the medication is stored and locked. There are always two (2) med-tech staff in there during the daytime. The outside/backyard is accessible to residents with different areas for them to sit. There is appropriate outdoor furniture for the residents to sit on with proper shading. There is no body of water. 809C-continued Common Areas: These include the dining areas, library, hair salon, and activities room. All common areas were observed to be cleaned and properly furnished. The library has sitting for residents and has books in several shelves. The activity room has a large television and has enough seating for several residents to watch the television and do different activities. Facility maintains a comfortable temperature of 72.-76-degree Fahrenheit. There are several temperature thermostats throughout the facility. There are several common bathrooms throughout the upstairs and downstairs area. The staff and resident bathrooms are not shared. There are trash cans with lids and covid signs posted in the common bathrooms. There is toilet paper and napkins. There are two facility laundry areas. One is located outside and has large washers and dryers with locked chemicals inaccessible to the residents. This laundry area has extra linen, and one is located inside that can be entered from the facility with a key. Next to the laundry room that is accessible from the facility is a shower area that residents can use if they cannot shower themselves or need a larger area to shower for example residents with wheelchairs. The Kitchen area was toured, and LPA observed there to be sufficient seven (7) day supply of non-perishable foods and perishable food for all residents. The kitchen area was clean at the time of the tour. The dining area is located next to the kitchen where different residents were having lunch with proper feeding utensils/plates/cups. Next to the kitchen/dining room area is a vending machine for residents and staff use. Administrative: There is no annual fee that is due right now. The Insurance plan is dated as of 09/12/23. There is a disaster plan manual located in the office of the facility where the staff and resident files are located. The last fire drill conducted was on 12-12-2023. An exit interview was conducted, no citations were issued, and a copy of this report was given to the administrator.the state’s words, verbatim · CDSS document, Jan 13, 2024

Allegation investigated: Facility staff are not seeking resident medical attention.

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. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jan 3, 2024 · control 31-AS-20231215150425

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.