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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609830
Report Date: 11/16/2022
Date Signed: 11/16/2022 04:17:03 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
11/08/2022 and conducted by Evaluator Abeye Duguma
COMPLAINT CONTROL NUMBER: 31-AS-20221108124742
FACILITY NAME:MELROSE GARDENS LA, LLC.FACILITY NUMBER:
197609830
ADMINISTRATOR:MARCO J VILLEGASFACILITY TYPE:
740
ADDRESS:960 N MARTEL AVETELEPHONE:
(323) 876-1746
CITY:LOS ANGELESSTATE: CAZIP CODE:
90046
CAPACITY:100CENSUS: DATE:
11/16/2022
UNANNOUNCEDTIME BEGAN:
10:04 AM
MET WITH:Marco VillegasTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Staff do not meet residents' incontinence needs.
Staff do not provide activities for residents.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced subsequent complaint visit to investigate the above allegations. LPA met with the Executive Director, Marco Villegas, and discussed the reason for the visit.

--- Staff do not meet residents' incontinence needs.
It was alleged that residents are not being changed regularly. To investigate the allegation, on 11/16/2022 at 10:15 AM, LPA made observations during a physical plant tour, at 11:00 AM, LPA interviewed residents and at 12:00 PM, LPA interviewed staff. During the physical plant tour, LPA did not experience any malodor and all observed residents were clean and well groomed. During interviews, Resident #2 (R2), Resident #3 (R3) and all staff stated that residents are changed regularly and that they are not left soiled for an extended period. Resident #1 (R1) stated that residents are not changed timely. Based on observations and interviews, there is not enough information to verify the allegation, therefore, the allegation is unsubstantiated at this time.
(Cont. on LIC9099)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye DugumaTELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 31-AS-20221108124742
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 GARDENS LA, LLC.
FACILITY NUMBER: 197609830
VISIT DATE: 11/16/2022
NARRATIVE
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--- Staff do not provide activities for residents.

It was alleged that there are no activities for the residents. To investigate the allegation, on 11/16/2022 at 10:15 AM LPA made observations during a physical plant tour, at 10:50 AM, LPA requested records, at 11:00 AM, LPA interviewed residents and at 12:00 PM, LPA interviewed staff. During the physical plant tour, LPA observed residents partaking in activities. LPA also observed activities posted on boards in common areas. During interviews with Staff #1 (S1), they stated that the facility has various activities for residents and provided records to show both current and previous planned activities. During interviews, R1 stated that the facility does not have enough activities for residents, but the remaining interviewed residents stated that the facility does have planned activities. Interviews with staff also revealed that there are several activities for the resident to participate in. Based on record reviews and interviews, there is not enough information to verify the allegation, therefore, the allegation is unsubstantiated at this time.



No health and safety hazards noted during the visit.

Exit interview conducted and a copy of the report was issued.
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye DugumaTELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3