197609076-6-20-2025-31-AS-NMAN-DU9W3Q-20260520165615

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609076
Report Date: 06/20/2025
Date Signed: 06/20/2025 03:41:19 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
06/13/2025 and conducted by Evaluator Raymond Comer

COMPLAINT CONTROL NUMBER: 31-AS-20250613093622

FACILITY NAME:	MELROSE VILLAS		FACILITY NUMBER:	197609076
ADMINISTRATOR:	VERGARA, KANDICE		FACILITY TYPE:	740
ADDRESS:	823 N POINSETTIA PLACE		TELEPHONE:	(323) 746-7840
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90046
CAPACITY:	68	CENSUS: 46	DATE:	06/20/2025
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Lori McKay		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff do not ensure that facility telephone is operable-
Staff are not maintaining the facility clean-
Staff provide inadequate food services to residents-

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Today, Friday, 6/20/25, at 8:00 am, Licensing Program Analyst, (LPA) Raymond Comer, conducted an unannuouned, initial10- day visit to investigate the above allegation(s). LPA met with Administrator, Lori McKayl, presented official CDSS badge identification, and reason for the visit was disclosed.

At 8:15 am, LPA conducted a physical plant tour; no health and safety issues were observed.

To investigate this allegation, LPA received facility resident roster, and staff roster. From 8:30 am to 10:00 am, LPA reviewed Resident#1's file. From 10:20 am to 11:05 am, LPA conducted a tour of facility common areas, and random inspection of resident bedroom. From 11:15 am, to 1:30pm, LPA interviewed residents and staff.

[LIC9099C]-Continued

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2025

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 3

Control Number 31-AS-20250613093622

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 VILLAS	FACILITY NUMBER: 197609076
	VISIT DATE: 06/20/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Allegation:Staff do not ensure that facility telephone is operable- Reporting Party (RP) alleges that facility does not provide active telephone service for several weeks in month of June 2025.
LPA observation of facility revealed the following: Facility's hardwire telephone system and resident-available cell phone are confirmed with active dial tone; phone and internet services are working properly.
LPA interviews with staff revealed the following: Both the Administrator, and Staff#1 (S1) refute the allegation, stating that although there was a brief phone/internet service outage lasting a maximum of three (3) hours in the month of June, the facility continued to maintain active service access via cell phone. Staff state that all residents have access to either the facility's desk phone in the front lobby, or the facility provide cell phone. Staff state that resident#1 (R1) was offered access to facility provided cell phone service at the time of the brief service disruption.
LPA interviews with residents revealed the following: Out of a total of forty-six (46) residents, Six (6) out of six (6) residents state there has been no significant phone/internet disruptions at the facility lasting more than a few hours, and confirm having ready access the telephone/internet service provided by the facility.

Based on the information gathered during this visit, this allegation is unsubstantiated at this time.

Allegation: Staff do not maintain a clean facility- Reporting Party (RP) alleges that facility does not keep the facility clean, stating that "...there is dust all over the furniture".
LPA tour of the facility revealed the following: LPA observed facility common areas (i.e., dining room, television\activities room, hallways, and patio area) as clean and clear of clutter. LPA conducted observations of random resident bedrooms and found them as clean, free of dirt, dust and clutter.
LPA interviews with staff revealed the following: Both the Administrator, and Staff#1 (S1) refute the allegation, stating that housekeeping staff clean common areas and resident bedrooms on a daily basis.
LPA interviews with residents revealed the following: Out of a total of forty-six (46) residents, Six (6) out of six (6) residents confirm their satisfaction with level of cleanliness provided by housekeeping staff.

Based on the information gathered during this visit, this allegation is unsubstantiated at this time.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 31-AS-20250613093622

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 VILLAS	FACILITY NUMBER: 197609076
	VISIT DATE: 06/20/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Allegation: Staff provide inadequate food services to residents- Reporting Party (RP) alleges that facility provide poor quality food and that staff "...primarily serve carbohydrates" which suggests a lack of vegetables, fruits, and meats nutrition.
LPA observation of facility revealed the following: Facility's kitchen maintains a variety of fresh vegetables, fruits, meats, breads and other food items; no foods were observed as unhealthy or rotting. LPA observed refrigerators and walk in freezers working properly and all foods were wrapped and labeled accordingly. LPA observed a four-week calendar of food items which display a balanced variety of food options.
LPA interviews with staff revealed the following: The Administrator refutes the allegation, stating that R1 is provided balanced, nutritious meals composed of a variety of vegetables, meats, fruits and carbohydrates.
LPA interviews with residents revealed the following: Out of a total of forty-six (46) residents, five (5) out of six (6) residents state their satisfaction with the meals prepared and served by food service staff..

Based on the information gathered during this visit, this allegation is unsubstantiated at this time.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 3