197609724-5-17-2023-31-AS-NMAN-CSHS9Z-20230605134135

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609724
Report Date: 05/17/2023
Date Signed: 05/17/2023 04:01:08 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
12/28/2022 and conducted by Evaluator LaQueena Lacy

COMPLAINT CONTROL NUMBER: 31-AS-20221228145127

FACILITY NAME:	MELROSE CHATEAU		FACILITY NUMBER:	197609724
ADMINISTRATOR:	VERGARA, KANDICE		FACILITY TYPE:	740
ADDRESS:	819 N POINSETTIA PL		TELEPHONE:	(310) 413-8717
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90046
CAPACITY:	12	CENSUS: 7	DATE:	05/17/2023
		UNANNOUNCED	TIME BEGAN:	02:22 PM
MET WITH:	Alexcis Peralta		TIME COMPLETED:	04:05 PM

ALLEGATION(S):

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Staff is financially abusing resident in care.
Staff did not accord resident privacy on a phone call.

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 was alleged that resident #1 (R1) may be a subject of possible financial exploitation at the assisted living facility. To investigate the above allegation LPA conducted interviews with staff on 12/28/2022 at approximately 2:38PM, and R1 on 01/13/2023 at 11:18AM. Staff denied any involvement with R1’s finances. R1 confirmed that they had filed a fraud claim with the bank in August 2022 disputing debit card transactions made against their account. During the investigation, R1 affirmed that no staff at the facility had made any unauthorized purchases with their debit card and feels that the facility staff take good care of them. Staff assist R1 when needed, and R1 is very verbal to staff if there is something that they are not doing properly.
Continued on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: LaQueena Lacy
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-20221228145127

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 CHATEAU	FACILITY NUMBER: 197609724
	VISIT DATE: 05/17/2023

NARRATIVE

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A review of R1’s physician report conducted on 12/28/2022 at 2:26pm, revealed that R1 is able to communicate their needs and able to manage their own cash resources. Based on interviews, observations, and record review there is not enough corroborating 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.

2. Staff did not accord resident privacy on a phone call.

It is alleged that staff was on the line, when resident #1 (R1) contacted the bank. Staff asked R1 to confirm their balance in his new account along with other reminders. To investigate the above allegation LPA conducted interviews with staff on 12/28/2022 at approximately 2:38PM, and R1 on 01/13/2023 at 11:18AM. Interview with R1 confirms that R1’s case manager assists them with conducting their personal business and they do not know the person named as the staff member that was suppose to be assisting R1 on the phone. They have never had help from the person named and no staff member by that name works at the facility. Interviews with facility staff confirm that R1 is getting assistance from the case manager who is not facility staff. A review of R1’s physician report conducted on 12/28/2022 at 2:26pm revealed that they have periods of mild confusion. Based on interviews, observations, interviews and record review there is not enough corroborating evidence to prove the alleged violation did 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.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: LaQueena Lacy
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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