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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609076
Report Date: 04/27/2026
Date Signed: 04/27/2026 01:19:34 PM

Substantiated


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
03/26/2025 and conducted by Evaluator Mariana Agban
COMPLAINT CONTROL NUMBER: 31-AS-20250326163124
FACILITY NAME:MELROSE VILLASFACILITY NUMBER:
197609076
ADMINISTRATOR:VERGARA, KANDICEFACILITY TYPE:
740
ADDRESS:823 N POINSETTIA PLACETELEPHONE:
(323) 746-7840
CITY:LOS ANGELESSTATE: CAZIP CODE:
90046
CAPACITY:68CENSUS: 48DATE:
04/27/2026
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Candis Allen- AdministratorTIME COMPLETED:
01:40 PM
ALLEGATION(S):
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Staff did not ensure resident's room was free of bed bugs
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mariana Agban conducted an unannounced subsquent complaint visit for the above allegation. LPA arrived and was greeted by the receptionist and met with the Adminisistrator Candis Allen and explained the reason for the visit

Regarding the allegation Staff did not ensure resident's room was free of bed bugs:

It is alleged that Resident #1’s (R1) room had bed bugs for several months. LPA conducted interviews with five staff members, all of whom confirmed the allegation. Additionally, interviews conducted on 04/02/25 with three out of seven residents also confirmed the presence of bed bugs in the facility.During the initial visit, the LPA conducted a physical plant tour and did not observe any bed bugs in resident rooms at the time of inspection. The LPA inspected Rooms #109, #211, #220, #102, #113, #103, and #206.

(Continue on 9099C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2026
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 5
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
03/26/2025 and conducted by Evaluator Mariana Agban
COMPLAINT CONTROL NUMBER: 31-AS-20250326163124

FACILITY NAME:MELROSE VILLASFACILITY NUMBER:
197609076
ADMINISTRATOR:VERGARA, KANDICEFACILITY TYPE:
740
ADDRESS:823 N POINSETTIA PLACETELEPHONE:
(323) 746-7840
CITY:LOS ANGELESSTATE: CAZIP CODE:
90046
CAPACITY:68CENSUS: 48DATE:
04/27/2026
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Candis Allen- AdministratorTIME COMPLETED:
01:40 PM
ALLEGATION(S):
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9
Unqualified staff administering medication
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mariana Agban conducted an unannounced subsquent complaint visit for the above allegation. LPA arrived and was greeted by the receptionist and met with the Adminisistrator Candis Allen and explained the reason for the visit.

Regarding allegation Unqualified staff administering medication.
It is alleged that unqualified staff (Staff #1, S1) administered insulin injections to Resident #1 (R1). LPA conducted interviews with four staff members, all of whom denied the allegation. Additionally, interviews conducted with six out of seven residents did not support the allegation.LPA reviewed R1’s Physician’s Report dated 04/09/2024, which did not indicate a diagnosis of diabetes and there was no documentation indicating that insulin injections were prescribed. Interviews with Staff #3 (S3) and Staff #4 (S4) confirmed that R1 has never been prescribed insulin and stated that facility staff are not permitted to administer injections. (Continue on 9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 31-AS-20250326163124
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: 04/27/2026
NARRATIVE
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LPA also reviewed R1’s current medication list and did not observe any insulin injections prescribed. Based on interviews conducted and records reviewed, there is insufficient evidence to support the allegation. Therefore, the allegation is deemed Unsubstantiated at this time.

Exit interview conducted, copy of this report signed and delivered.
SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 31-AS-20250326163124
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: 04/27/2026
NARRATIVE
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Interviews with Staff #1 (S1) and Staff #2 (S2) indicated that the facility previously contracted with a pest control company; however, the services were ineffective, and the contract was subsequently terminated. Staff #3 (S3) reported that the facility currently receives bed bug treatment services at least once per month and on an as-needed basis. S3 provided copies of invoices and pest sighting/evidence logs to support ongoing pest control efforts. Based on interviews and documentation obtained, there is sufficient evidence to support the allegation. Therefore, the allegation is deemed Substantiated at this time.

Exit interview was conducted. Citation was issued per Title 22 Division 6 of the CA Code of Regulations. Appeal rights were provided, and a copy of this report was reviewed with, signed by, and delivered to the facility Administrator.
SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 31-AS-20250326163124
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/27/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/27/2026
Section Cited
CCR
87303(a)
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The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by:
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Administrator provided copies of invoices and pest sighting/evidence logs to support ongoing pest control efforts. Bed bug treatment services is conducted at least once per month and on an as needed basis. POC is cleared.
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Based on interviews and records reviews, the licensee did not comply with the section cited above. Staff did not ensure resident's room was free of bed bugs. This poses an a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5