197609076-4-2-2026-31-AS-NMAN-DT3QC2-20260412120223

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609076
Report Date: 04/02/2026
Date Signed: 04/02/2026 02:03:53 PM

Substantiated

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
03/23/2026 and conducted by Evaluator Raymond Comer

COMPLAINT CONTROL NUMBER: 31-AS-20260323085304

FACILITY NAME:	MELROSE VILLAS		FACILITY NUMBER:	197609076
ADMINISTRATOR:	ALLEN, CANDIS		FACILITY TYPE:	740
ADDRESS:	823 N POINSETTIA PLACE		TELEPHONE:	(323) 746-7840
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90046
CAPACITY:	68	CENSUS: 50	DATE:	04/02/2026
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Candis Allen - Administato		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Improper eviction.

INVESTIGATION FINDINGS:

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On Thursday, 04/02/26, Licensing Program Analyst, (LPA) Ray Comer, arrived to conduct an unannounced initial 10-day visit to investigate the allegation. LPA met with the Administrator, presented official CDSS badge identification, and reason for the visit was disclosed.

LPA conducted a physical plant tour at 9:50 am; no health or safety issues were observed.
Prior to this visit, on 03/20/26 LPA Comer received and reviewed a copy of the eviction notice submitted by the facility Administrator.

During this investigation, At 10:15 am, LPA Comer requested and reviewed the facility resident roster, staff roster, Resident #1's (R1's) admission agreement, Physician's Report (LIC602), Appraisal Needs and Services, copy of 30 day eviction notice previously submitted to R1, and Unusual Incident Reports involving R1. Between 11:15 am and 12:30pm LPA conducted interviews with Administrator, R1, and R1's POA/Conservator.

[LIC9099-C] Continued

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:	DATE: 04/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2026

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-20260323085304

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: 04/02/2026

NARRATIVE

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Allegation: Improper Eviction- It was alleged that the eviction notice that was provided to resident #1 (R1), and their POA\Conservator was improperly executed as it was missing clear and specified reasons why R1 is being evicted.

Prior to this visit on 03/20/26 LPA Comer received and reviewed a copy of the eviction notice submitted by the facility Administrator. The information provided on the notice was not clear and did not follow Title 22 requirements.

LPA interviews with facility Administrator revealed the following: R1 had successfully attempted multiple elopements during R1's tenure as a facility resident. Per Administrator, R1 was provided with an eviction notice dated 3/20/2026, which explains that at this time the facility is not able to provide adequate care and supervision to R1 due to their behaviors posing hazard to themselves and others.

R1, and their responsible party verified that R1 has no issues and concerns with the facility, and R1 could not recall any AWOL incident.

A review of R1’s facility records and other pertinent documents revealed that R1 is a long-term resident of the facility and there are no previous records to identify changes in R1's physical, mental and psychological condition. Per physician report, R1 is able to leave facility unassisted. Information received revealed that R1 may have behavioral outbursts. However, there is no verification that R1's behavior poses hazard to themselves or others.

Based on interview and record review, the facility may have reasonable ground for eviction. However, there is no measurable and verifiable information and evidence to support recent eviction notice issued to R1. License has not provided the documented due diligence to prove R1's change of mental/psychological condition that may cause harm to R1' s self, nor to the community. Therefore, the allegation is substantiated at this time.
Under Title 22, Division 6, Chapter 8, the following citation was issued and recorded on LIC9099D.

No immediate health and safety hazard is noted during this visit.
Appeal rights discussed and provided. Exit interview conducted and copy of report provided to Administrator.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:	DATE: 04/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2026

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20260323085304

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/02/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/02/2026 Section Cited CCR 87224(d)	1 2 3 4 5 6 7	Eviction Procedures (d)The licensee shall set forth in the notice to quit the reasons relied upon for the eviction with specific facts to permit determination of the date, place, witnesses, and circumstances concerning those reasons...This requirement is not met by:	1 2 3 4 5 6 7	Licensee shall review eviction procedures and submit a statement of understanding to the department by POC due date 04/16/2026
	8 9 10 11 12 13 14	Based on interviews and record reviews, the licensee did not ensure 30 day eviction was in compliance with Title 22, which poses in potential Health, Safety or Personal Rights risks to person in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:	DATE: 04/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2026

LIC9099 (FAS) - (06/04)

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