197610370-11-14-2024-31-AS-AJWR-DP68PZ-20251207214218

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610370
Report Date: 11/14/2024
Date Signed: 11/14/2024 07:13:57 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
11/04/2024 and conducted by Evaluator Raymond Comer

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20241104095811

FACILITY NAME:	MELROSE GARDENS		FACILITY NUMBER:	197610370
ADMINISTRATOR:	VILLEGAS, MARCO		FACILITY TYPE:	740
ADDRESS:	960 N. MARTEL AVENUE		TELEPHONE:	(323) 876-1746
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90046
CAPACITY:	100	CENSUS: 54	DATE:	11/14/2024
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Marco Villegas		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff did not distribute residents' medications as prescribed-

Staff did not safeguard residents' personal belongings-

INVESTIGATION FINDINGS:

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On Thursday, 11/14/24, Licensing Program Analyst, (LPA) Raymond Comer, conducted an unannounced, initial 10-day complaint visit at the facility to investigate the above allegation(s). LPA met with Executive Director, Marco Villegas, and the reason for the visit was disclosed.

At 10:15 am, LPA conducted a physical plant tour; no health and safety issues were observed.

To investigate the allegation(s), LPA received Facility Resident roster, and Staff roster. At 10:30 am, LPA conducted a review of Resident files. Between 11:15 am and 12:35 pm, LPA interviewed the Executive Director, Staff, and Conservator. At 1:00 pm, LPA conducted an observation and review of MAR documents in the facility medication room. Between 1:20 pm and 2:00 pm, LPA interviewed Residents.

[LIC 9099C]- Continued

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:	DATE: 11/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024

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-20241104095811

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 GARDENS	FACILITY NUMBER: 197610370
	VISIT DATE: 11/14/2024

NARRATIVE

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Allegation: Staff did not distribute residents' medications as prescribed- It was reported that, sometime between August 2024 and September 2024, Resident#1 (R1's) medication was missing/not distributed. Reporting Party (RP) states that staff instead gave R1 medication for another resident.

LPA's review of R1's Medical Administration Records (MAR's) refutes the claim that staff did not provide R1 their medication as prescribed. LPA interviews suggest that R1 has a history of accusing staff of not having their medication available, and instead, giving R1 medication meant for other residents. Five (5) out of five (5) residents interviewed by the LPA state Staff distributing their medications as prescribed by their physician.
Based on the information obtained through LPA observation, records review, and interviews, it cannot be proven that staff is failing to distribute residents their medications as prescribed. Therefore, the allegation is deemed Unsubstantiated at this time.

Allegation: Staff did not safeguard residents' personal belongings- It was reported that clothing belonging to Resident#3 (R3) and Resident#4 (R4) were missing, due to staff not providing proper safeguarding.

LPA observations and interviews with Staff, Residents, and Conservator revealed the following: Staff members state that no one has reported missing items for R3 and R4. The conservator for R4 states to LPA that none of R4's clothing items are missing, and witnessed the items in R4's bedroom during a recent visit. During LPA interview, R3 confirmed that all clothing items are in their room, and that they sometimes share some of their clothing items with their roommate. During LPA observation of R3's bedroom, the items listed on R3's inventory of personal property were found in their bedroom. Five (5) out of five (5) residents interviewed by the LPA state having no concerns with staff safeguarding of their personal belongings.

Based on the information obtained through LPA observations, and interviews, it cannot be proven that staff is failing to safeguard residents' personal belongings. Therefore, the allegation is deemed Unsubstantiated at this time.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:	DATE: 11/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024

LIC9099 (FAS) - (06/04)

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