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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609076
Report Date: 12/10/2024
Date Signed: 12/10/2024 02:53:35 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
12/04/2024 and conducted by Evaluator Raymond Comer
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20241204111738
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: 50DATE:
12/10/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Saul ArandaTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Licensee is not addressing pests at the facility-

INVESTIGATION FINDINGS:
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On Tuesday, 12/10/2024, Licensing Program Analyst, (LPA) Raymond Comer, conducted the initial10-day complaint visit at the facility.

At 10:05 am, LPA met with facility representative, Saul Aranda, and the purpose of the visit was disclosed.

A physical plant tour of the facility was conducted. No health and safety issues were observed.

Allegation: Licensee is not addressing pests at the facility- The Reporting Party (RP) alleges that faciity is not addressing incidents of bed bugs and roaches observed in resident bedrooms.

[LIC 9099-C Continued]---

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 31-AS-20241204111738
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: MELROSE VILLAS
FACILITY NUMBER: 197609076
VISIT DATE: 12/10/2024
NARRATIVE
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To investigate the allegation, LPA conducted records review from 10:20 am to 11:10 am, room observations from 11:25 am to 11:50 am, interview with Staff from 12:05 pm to 12:30 pm, and interview with residents from 12:45 pm to 1:30pm.

LPA review of facility documents reveal in late September 2024, staff communicating with the facility's pest control vendor (Terminix) concerning observation of bed bugs and roaches observed in resident bedrooms. From October 2024 to the present, Pest Control Vendor has completed both chemical and heat treatments eradicating pests from resident rooms. At this time, bedrooms #102 and #205 have been treated for pests, been provided post-inspection by the pest control vendor, finding these rooms observed as "pest-free".
LPA observation found that new bed mattresses (box springs are encased in plastic liner) and furniture has been replaced in pest-treated rooms. Additionally, Pest control vendor is scheduled to continue pesticide treatments to all remaining areas throughout the facility.
LPA also conducted interview with facility residents and staff. LPA interview with the staff revealed that the bed bug issue originated with R2 stockpiling items off the street and into their room; Licensee is working with R2's case worker to address this issue. LPA interview with residents revealed that four (4) out of five (5) residents state there are no pest issues at the facility.

Based on the information obtained through LPA observation, records review, and interviews, it cannot be proven that staff fails to address pests at the facility. Therefore, the allegation is deemed Unsubstantiated at this time.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2024
LIC9099 (FAS) - (06/04)
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