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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609076
Report Date: 12/28/2022
Date Signed: 12/28/2022 03:04:57 PM

Unfounded


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
12/23/2022 and conducted by Evaluator LaQueena Lacy
COMPLAINT CONTROL NUMBER: 31-AS-20221223085910
FACILITY NAME:MELROSE VILLASFACILITY NUMBER:
197609076
ADMINISTRATOR:VERGARA, KANDICEFACILITY TYPE:
740
ADDRESS:823 N POINSETTIA PLACETELEPHONE:
(323) 746-7840
CITY:LOS ANGELESSTATE: CAZIP CODE:
90046
CAPACITY:68CENSUS: 54DATE:
12/28/2022
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Alexcis PeraltaTIME COMPLETED:
02:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff is financially abusing resident in care.
Staff did not accord resident privacy on a phone call.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) LaQueena Lacy conducted an unannounced ten (10) day complaint visit to the facility to investigate the above allegations. LPA met with staff Alexcis Peralta and explained the purpose for the visit.

This agency has investigated the complaint alleging that staff #1 (S1) was financially abusing R1, and did not accord R1 privacy while on the phone. During the investigation it was determined that R1 does not live at Melrose Villas. R1 resides currently at the sister facility Melrose Chateau. We have found that the complaint was without a reasonable basis. We have therefore dismissed the complaint.

No health and safety hazard is noted during this visit.

Exit interview was conducted and copy of report was issued.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: LaQueena LacyTELEPHONE: (818) 661-0002
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2022
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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