197609076-9-28-2020-31-AS-CHAS-BUKRN7-20201020130949

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609076
Report Date: 09/18/2020
Date Signed: 09/28/2020 02:45:30 PM

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
06/24/2020 and conducted by Evaluator Rosaura Valenzuela

COMPLAINT CONTROL NUMBER: 31-AS-20200624155328

FACILITY NAME:	MELROSE VILLAS		FACILITY NUMBER:	197609076
ADMINISTRATOR:	VERGARA, KANDICE		FACILITY TYPE:	740
ADDRESS:	823 N POINSETTIA PLACE		TELEPHONE:	(323) 746-7840
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90046
CAPACITY:	68	CENSUS: 61	DATE:	09/18/2020
		UNANNOUNCED	TIME BEGAN:	01:41 PM
MET WITH:	Kandice Vergara, Administrator		TIME COMPLETED:	01:43 PM

ALLEGATION(S):

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Facility staff failed to keep facility clean

Facility staff smoke on the facility premises

Facility is infested with rodents

Facility staff yell at residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced visit to deliever the findings on the above allegations. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19) and to implement mitigation measures, today's visit was conducted telephonically with facility administrator Kandice Vergara.

Allegation #1: Facility staff failed to keep facility clean. To investigate this allegation, LPAs Valenzuela and Gillyard conducted an unannounced visit on 7/6/20 and at 11:05am began a physical tour of the facility. Patio, common areas, kitchen, dinning room, bathrooms, and resident rooms were inspected by LPAs. In addition, LPA Valenzuela interviewed the house keeper. The house keeper indicated that common areas are cleaned twice a day and that approximately 8-10 rooms are cleaned per week. Indeed, facility appeared clean and passageways were clear from obstruction.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: (818) 421-5360
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2020

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-20200624155328

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: MELROSE VILLAS	FACILITY NUMBER: 197609076
	VISIT DATE: 09/18/2020

NARRATIVE

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Based on the observation and information revealed during this investigation, there is no relevant information to support this allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

Allegation #2: Facility staff smoke on the facility premises. To investigate this allegation, LPA Valenzuela interviewed staff on 7/6/20 at 11:20am. Staff confirmed that they smoke outside of the facility, in the patio area, during their breaks. Inside of the facility, no one is allowed to smoke since there is a resident that uses an oxygen tank.

Based on the interview conducted and observation there is nothing to support this allegation. Thus, the allegation is UNSUBSTANTIATED.

Allegation #3: Facility is infested with rodents. To investigate this allegation, LPAs conducted a physical tour of the facility at 11:05am on 7/6/20. At no time did LPAs observe any rodents or droppings. In addition, facility residents were interviewed at 11:30am and all indicated that they have not seen any rodents in their rooms or inside the facility. House keeper was also interviewed at 11:15am and stated that rodents have not been seen on the premises.

Based on the plant tour and interviews revealed during the investigation, there is no relevant information to support this allegation. Therefore, the allegation is UNSUBSTANTIATED.

Allegation #4: Facility staff yell at residents. To investigate this allegation, LPA Valenzuela spoke to facility clients on 7/6/20 at 11:30am. and they all denied being yelled at by the facility staff. Interviews revealed that the facility staff is respectful and that clients feel safe living inside the facility.

Based on the interviews conducted there is no relevant information to support this allegation. Thus, the allegation is UNSUBSTANTIATED.

This concludes the investigation.

Exit interview conducted. Signature obtained on hard copy of the report.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: (818) 421-5360
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2020

LIC9099 (FAS) - (06/04)

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