197609076-6-2-2023-31-AS-NMAN-CT2UDH-20230622152935

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609076
Report Date: 05/17/2023
Date Signed: 06/02/2023 12:35:32 PM

Unsubstantiated

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
01/11/2023 and conducted by Evaluator LaQueena Lacy

COMPLAINT CONTROL NUMBER: 31-AS-20230111112945

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: 59	DATE:	05/17/2023
		UNANNOUNCED	TIME BEGAN:	12:34 PM
MET WITH:	Alexcis Peralta		TIME COMPLETED:	03:20 PM

ALLEGATION(S):

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Staff is sexually abusing resident in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) LaQueena Lacy conducted an unannounced subsequent complaint visit to deliver findings on 05/17/2023. Upon arrival LPA LaQueena Lacy met staff Alexcis Peralta and explained the purpose of this visit.

It is alleged that witness #1 (W1) witnessed R1 being sexually abused by a staff member at the facility. To investigate the above allegation, on 01/11/2023 LPA requested documents relevant to the investigation at 12:30pm. LPA began interviews with staff and residents at approximately 2:15pm- 3:50pm and additional interviews with staff and residents on 01/13/2023 at approximately 11:45am. Interviews with five (05) out of (05) resident revealed they have not witnessed any staff members sexually assaulting or touching any residents inappropriately. They have not been told by any residents that they are being sexually abused or inappropriately touched by any staff members.
Cotinued on 9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: LaQueena Lacy	TELEPHONE: (818) 661-0002
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023

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-20230111112945

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: 05/17/2023

NARRATIVE

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R1 affirmed that they have not been sexually abused or inappropriately touched by any staff and have not been forced to do anything sexually inappropriate. Interviews with staff confirm they speak to W1 on a daily basis, and they never reported any issues to staff. During the investigation, (W1) affirms they “never witnessed R1 being sexually abused by a staff member, and never made a complaint about anything like that, and does not know who did”. Based on interviews, and observations, there is not enough evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED at this time.

No health and safety hazards are noted during this visit.

No deficiencies cited, exit interview conducted, copy of report and appeal rights issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: LaQueena Lacy	TELEPHONE: (818) 661-0002
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023

LIC9099 (FAS) - (06/04)

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