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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610370
Report Date: 04/30/2024
Date Signed: 06/05/2024 09:30:08 AM

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
04/25/2024 and conducted by Evaluator Raymond Comer
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20240425102904
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: 54DATE:
04/30/2024
UNANNOUNCEDTIME BEGAN:
12:58 PM
MET WITH:Jenifer RiveraTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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9
Staff do not allow resident to have visitors
INVESTIGATION FINDINGS:
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This is an amendment of the original complaint report (LIC 9099) issued on 04/30/24. Report was amended to correct verbiage and maintain the confidentiality of Complaintant.

Licensing Program Analysts (LPAs), Raymond Comer and Micheal Cava, conducted Health and Safety Inspection of the Facility at 1:20 PM; no issues observed. LPAs spoke with Wellness Director. (S1) They state the Facility does not prohibit residents visitation rights. LPAs spoke with the Reporting Party (RP) who says the Facility Administrator, Marco Villegas, specifically is prohibiting Resident #1's (R-1) family member from visiting at the facility. Additional information obtained from the RP during the investigation indicates that the family member in question lives in a different Adult Care Facility (West Los Angeles VA Home for Heroes) and the medical team at that Facility is temporarily not allowing them to leave their campus at this time. LPAs conducted an interview with Staff at West Los Angeles VA Home for Heroes and were advised that their Resident was currently unable to visit R-1 pending a complete medical evaluation by the Primary Care Physician. LPAs interviewed the Administrator, Marco Villegas, who states that he has spoken with R1, however, he did not tell R1 that their family member was prohibited from visiting the Facility,

Based on interviews, there is not sufficient information to support this allegation. Therefore, this allegation is UNSUBSTANTIATED at this time.”
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) -596-4373
LICENSING EVALUATOR NAME: Raymond ComerTELEPHONE: 818-401-8655
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024
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 2
Control Number 31-AS-20240425102904
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: 04/30/2024
NARRATIVE
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LPAs' spoke with Staff for the family member of R#1. Staff communicated that the Family Member in question is currently not able to visit R#1 until their Primary Care Physician has completed a medical evaluation.

Based on interviews, there is not sufficient information to support this allegation. Therefore, this allegation is UNSUBSTANTIATED at this time.

SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) -596-4373
LICENSING EVALUATOR NAME: Raymond ComerTELEPHONE: 818-401-8655
LICENSING EVALUATOR SIGNATURE:

DATE: 04/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2