197610370-9-24-2024-31-AS-TAGD-DBUPYL-20241211104408

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610370
Report Date: 09/24/2024
Date Signed: 09/24/2024 01:57:35 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.ASC, 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
05/07/2024 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20240507132704

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: 55	DATE:	09/24/2024
		UNANNOUNCED	TIME BEGAN:	09:03 AM
MET WITH:	Marco Villegas - Executive Director		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff does not ensure facility serves food of good quality and quantity to residents

Staff does not ensure residents are spoken to in an appropriate manner

Staff do not ensure medications are properly managed for residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegations. LPA met with Executive Director Marco Villegas and explained the reason for the visit.

LPA conducted physical plant tour at 9:33 AM, requested copies of facility documents relevant to the investigation at 10:05 AM and interviewed staff and residents between 11:00 AM to 1:00 PM. Regarding the allegation that Staff does not ensure facility serves food of good quality and quantity to residents, it was alleged that the food quality is not very good, quantity of food portions is also very small and the facility runs out of food. LPA's observation during today's visit at about 10:30 AM revealed that the facility has more than enough stock of food in their walk in refrigerator including but not limited to eggs, milk, vegetables and lots of meat. LPA's interview with kitchen staff today at 11:30 AM revealed that they have food deliveries every Tuesday and Wednesday of every week. Further interview also revealed that kitchen staff allot about 10% for second servings or more, depending on the requests of the residents. (continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024

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-20240507132704

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: MELROSE GARDENS	FACILITY NUMBER: 197610370
	VISIT DATE: 09/24/2024

NARRATIVE

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(continued from LIC 9099)

LPA's interview with six (6) random residents today or 10% of the current census between 11:00 AM to 1:00 PM and two (2) residents on 05/08/24 revealed that eight (8) out of eight (8) residents interviewed revealed that the food being served is of good quality and sufficient.

Regarding the allegation Staff does not ensure residents are spoken to in an appropriate manner, it was alleged that Staff #1 (S1) was very rude when S1 speaks and yells at residents. LPA's interview with three (3) staff who were present during the incident with Resident #1 (R1) and Resident #2 (R2) revealed that R1 and R2 were the ones yelling at S1 on those incidents and not the other way around. LPA's interview with eight (8) residents during this and prior visit also revealed that eight (8) out of (8) residents did not witness S1 being rude and/or yelled at any resident but witnessed R1 and R2 yelling at the reception area.

Regarding the allegation that Staff do not ensure medications are properly managed for residents, it was alleged that R1's medication are not getting refilled and did not ensure that R1's prescription is getting re-ordered. LPA's record on 05/08/24 at around 1:30 PM revealed that R1 has a PRN (As needed) medication that was not covered by R1's insurance that caused the delay of R1's medication. LPA's interview with staff on 05/08/24 at about 12:00 PM revealed that R1's medication was ordered by the pharmacy for ninety (90) days’ supply and was not approved by the insurance due to volume and that the staff made a call to the pharmacy and ordered a one week or (7) days’ supply of this medication instead and R1's insurance approved it. Further interview with staff also revealed that it was a Narcotic drug and R1's doctor did not allow R1 to take it the way R1 wanted as it will conflict with R1's other medication.

Based on the information gathered during this and prior visit, these allegations are deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024

LIC9099 (FAS) - (06/04)

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