197609076-1-30-2024-31-AS-NMAN-D9WP82-20241010110448

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609076
Report Date: 01/30/2024
Date Signed: 01/30/2024 01:28:06 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
01/23/2024 and conducted by Evaluator Tihesha Smith

COMPLAINT CONTROL NUMBER: 31-AS-20240123102907

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: 57	DATE:	01/30/2024
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Alexis Peralta		TIME COMPLETED:	01:40 PM

ALLEGATION(S):

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Staff yells at residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tihesha Smith conducted an unannounced complaint investigation visit to investigate the above allegation. LPA Smith met with Alexis Peralta (Human Resources Director) and disclosed the purpose of the visit.

Staff yells at residents

To investigate this allegation LPA requested facility documents,and conducted interviews with staff and resident between 11:05 -1pm. LPA interviews with six (6) of six (6) staff revealed they have not yelled at residents or witness any staff yelling at residents in care. Staff #4 (S4) and Staff # 6 (S6) revealed staff and residents have a bound of respect. Staff #2 (S2) revealed have yelled and talk firmly to a vendor that had disrespected residents in the past but have not yelled at the residents. Staff # 1 (S1) and (S2) revealed staff may talk louder to residents with impaired hearing.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Tihesha Smith	TELEPHONE: 818-307-6280
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

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-20240123102907

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: 01/30/2024

NARRATIVE

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(Cont from 9099)

Interview with six (6) of seven (7) residents revealed staff have not yelled at them and have not witnessed any staff yelling at residents in care. One (1) of seven (7) residents revealed staff have yelled at them and other residents but was unable to recall dates of incidents and/or names of residents who were yelled at. Five (5) of seven (7) residents revealed staff are kind but can speak firmly when they need to.

Based on interviews, there is not sufficient information to verify this allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

Exit interview conducted and a copy of the report was issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Tihesha Smith	TELEPHONE: 818-307-6280
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

LIC9099 (FAS) - (06/04)

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