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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610370
Report Date: 06/13/2023
Date Signed: 06/13/2023 01:57:42 PM


Document Has Been Signed on 06/13/2023 01:57 PM - It Cannot Be Edited

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 GARDENSFACILITY NUMBER:
197610370
ADMINISTRATOR:VILLEGAS, MARCOFACILITY TYPE:
740
ADDRESS:960 N. MARTEL AVENUETELEPHONE:
(323) 876-1746
CITY:LOS ANGELESSTATE: CAZIP CODE:
90046
CAPACITY:100CENSUS: 41DATE:
06/13/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:03 PM
MET WITH:Marcos VillegasTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) LaQueena Lacy arrived at the facility on 06/13/2023 at 12:03PM to conduct a subsequent Pre-Licensing visit and met with the Administrator Marcos Villegas.

LPA conducted a physical plant tour at 12:14PM

At 12:28PM LPA inspected four (04) out of (06) exit doors equipped with the Delayed Egress Locking System (DELS) on the 1st and 2nd floor. Two (02) out of (04) exit doors were tested and observed to be operational and functioning properly. The DELS timer is set for 15 second, when activated a loud count down is initiated with multiple verbal commands, once the time has expired the door is unlocked and a loud blaring alarm is activated that can be heard throughout the building. The DELS is then only deactivated by staff inserting a key into the door frame lock to rest the system. (02) out of (04) exits where observed to not be operating or functioning properly. The exit door located of the 1st floor near room 107, when pressing or holding the exit bar the DELS is not activated and does not give any verbal warnings and no alarm is sounded. The exit door on the 2nd floor located near room 223 observed to be unconnected to a battery/power source due to no display of the timer. The facility is currently waiting for a part to be ordered to complete the necessary work for proper operation of the exit door.

The Facility currently is not in compliance with Title 22 Regulations at this time. During the time of the inspection LPA observed (02) out of (06) exit doors on the 1st and 2nd floors not operational or functioning properly. This report will be forwarded to the Centralized Application Bureau (CAB), once the proper operation of all DELS exit doors have been completed, the facility pre-license will be reviewed for approval.


Exit interview was conducted with Administrator Marcos Villegas and a copy of this report was provided.

SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: LaQueena LacyTELEPHONE: (818) 661-0002
LICENSING EVALUATOR SIGNATURE:
DATE: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/13/2023
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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