197610370-11-4-2024-31-AS-NMAN-DQHTJS-20260120134643

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610370
Report Date: 11/04/2024
Date Signed: 11/04/2024 03:22:53 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
10/29/2024 and conducted by Evaluator Raymond Comer

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20241029123550

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: 53	DATE:	11/04/2024
		UNANNOUNCED	TIME BEGAN:	08:25 AM
MET WITH:	Marco Villegas		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility staff do not provide adequate incontinent care-
Staff do not ensure resident's hygiene needs are being met-

INVESTIGATION FINDINGS:

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On Monday, 11/04/24, 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 08:35 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 9:05 am, LPA conducted a review of Resident 1's (R1) file, and documents relevant to the investigation. Between 9:40 am and 11:45 am, LPA interviewed the Executive Director, and R1's Responsible Family Member (F1), via cellphone. At 12:10 pm, LPA made multiple attemps, via cellphone, to contact the Reporting Party. (RP) However, the RP did not respond.

[LIC 9099C]- Continued

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2024

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-20241029123550

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: 11/04/2024

NARRATIVE

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Between 12:15 pm, and 2:00 pm, LPA interviewed two (2) Medical Technician Staff, and conducted an observation of R1's bedroom.

Allegation: Facility staff do not provide adequate incontinent care- It was reported, for an extended period of time, R1 had been left in soiled diapers. .

LPA's review of R1's Physician's report, and Appraisal/Needs Assessment reveals that R1 does not require assistance with bathing, dressing, toileting, and personal hygiene: Per R1's Primary Care Physician, (PCP) R1 is able to complete most Activities of Daily Living (ADL's) with minimal assistance. LPA observed R1 wearing clothes which were clean and dry. LPA observed R1's room finding it clean, and with no urine smell. R1's clothes hamper contained some worn clothing items, however no urine stains, nor smell present. Interviews with staff, and F1 reveal that R1 is consistent with accomplishing toileting needs on their own, with occasional assistance from staff.

Based on the information obtained through LPA observation, records review, and interviews, it cannot be proven that staff is failing to meet the resident's incontinent needs. Therefore, the allegation is deemed Unsubstantiated at this time.

Allegation: Staff do not ensure resident's hygiene needs are being met- It was reported that R1 was not assisted with showing, and tooth brushing tasks.

LPA's review of R1's Physician's report, and Appraisal/Needs Assessment state that R1 does not require assistance with bathing, and personal hygiene as R1 is able to complete these tasks with minimal assistance. LPA interview with responsible family member (F1) revealed the following: F1 visits R1 at least once per week. F1 says R1 sometimes refuses assistance with showering and tooth brushing. However, staff contact F1 when R1 refuses to staff assistance. Interviews with staff reveal that R1 will sometimes refuse their assistance. However, R1 will accept staff assistance with F1's encouragement when contacted.

Based on the information obtained through LPA records review, and interviews, it cannot be proven that staff is failing to ensure R1's hygiene needs are being met. Therefore, the allegation is deemed Unsubstantiated at this time.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2024

LIC9099 (FAS) - (06/04)

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