197609076-8-19-2026-31-AS-MGFS-DXDVX8-20260828164908

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609076
Report Date: 08/19/2026
Date Signed: 08/19/2026 12:52:11 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
03/24/2025 and conducted by Evaluator Mariana Agban

COMPLAINT CONTROL NUMBER: 31-AS-20250324142530

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: 53	DATE:	08/19/2026
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Darkis Giron		TIME COMPLETED:	01:10 PM

ALLEGATION(S):

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Resident sustained injuries due to neglect
Staff mismanaged Resident’s medication
Staff did not provide care in a timely manner

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mariana Agban conducted an unannounced subsequent complaint visit for the above allegations. LPA arrived and was greeted by the receptionist and met with the Administrator Designee Darkis Giron.

Regarding the Allegation: Resident Sustained Injuries Due to Neglect
It is alleged that on or around March 16, 2025, Resident 1 (R1) sustained injuries as a result of a fall. Interview with the Administrator, Candis Allen, revealed that she was hired as the Administrator after the alleged incident and was not aware of any incidents involving R1. LPA interviewed five (5) staff members and seven (7) residents; however, none of the individuals interviewed were able to verify the allegation. LPA also reviewed all Special Incident Reports (SIRs) for March 2025 and was unable to confirm that the alleged incident occurred. Based on the information obtained through interviews and record review, there is insufficient evidence to verify the allegation. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. (Continue on 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2026

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-20250324142530

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: 08/19/2026

NARRATIVE

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Regarding the Allegation: Staff Mismanaged Resident's Medication
It is alleged that R1 developed liver damage that may have been caused by medication administered by facility staff. It is also alleged that R1 may have received an incorrect medication or dosage. Interview with the Administrator revealed that medications are administered as prescribed and at the correct dosage. Interviews with seven (7) residents confirmed that medications are administered as prescribed by their physicians. Interview with Staff 2 (S2) revealed that staff are not permitted to change medication dosages or administer medications without a physician's order. LPA reviewed R1's medication records and found that R1's medications were administered as prescribed and documented accordingly. Based on the information obtained through interviews and record review, there is insufficient evidence to verify the allegation. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the Allegation: Staff Did Not Provide Care in a Timely Manner
It is alleged that R1 fell and called for staff assistance; however, staff did not respond to R1's room.
Interviews with the Administrator and five (5) staff members revealed that the facility's protocol is to check on residents every two (2) hours. Staff also reported that some residents receive checks every one (1) hour based on their individual needs. Additionally, LPA conducted a random test of the emergency call button at 12:08 p.m. A caregiver responded to the call at 12:09 p.m. Interviews with six (6) residents confirmed that staff provide care and assistance in a timely manner. Based on the information obtained through interviews, there is insufficient evidence to verify the allegation. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Exit interview conducted, copy of this report signed and delivered.

SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2026

LIC9099 (FAS) - (06/04)

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