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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609830
Report Date: 10/26/2020
Date Signed: 10/27/2020 08:52:26 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:MELROSE GARDENS LA, LLC.FACILITY NUMBER:
197609830
ADMINISTRATOR:ELDATI, SAHARFACILITY TYPE:
740
ADDRESS:960 N MARTEL AVETELEPHONE:
(323) 876-1746
CITY:LOS ANGELESSTATE: CAZIP CODE:
90046
CAPACITY:100CENSUS: 32DATE:
10/26/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Denise RomeroTIME COMPLETED:
10:30 AM
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Licensing Program Analysts (LPA) conducted a case management visit to follow up with the notice sent to the facility regarding an immediate removal of the staff #1 (S1) from the facility due to issues related the criminal record clearance.
Due to the situation surrounding the Corona Virus Disease 2019 (COVID-19), and to implement mitigation measures, today’s visit was conducted telephonically. .
The purpose of this visit was discussed with Executive Director (ED). ED indicated that they did not receive a notice From Criminal Record Background Check Bureau. ED stated that S1 does not work for the facility since 10/01/20,
LPA Margaryan forwarded a copy of the letter to ED and requested to complete the report and e-mail completed copy back to the CCLD.
Based on evidence obtained during today’s visit, the LPA has verified the individual is not present, employed or residing at the facility. LPA has advised the licensee to disassociate the individual from their roster and submit and updated LIC500.
Verification of removal is complete.
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Naira MargaryanTELEPHONE: (818) 216-9775
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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