197610370-12-4-2025-31-AS-NMAN-DQHTJR-20260120134643

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610370
Report Date: 12/04/2025
Date Signed: 12/04/2025 02:50:09 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
10/29/2024 and conducted by Evaluator Raymond Comer

COMPLAINT CONTROL NUMBER: 31-AS-20241029123550

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: 30	DATE:	12/04/2025
		UNANNOUNCED	TIME BEGAN:	10:05 AM
MET WITH:	Joseph "Yossi" Wieder-Administrator		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff does not ensure resident receives adequate food service.
Facility is not kept clean and sanitary.
Staff do not ensure that resident has clean linen.

INVESTIGATION FINDINGS:

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At 10:05 am, Thursday, 12/04/25, Licensing Program Analyst, (LPA) Raymond Comer, arrived to conduct a subsequent complaint investigation regarding the allegation(s) listed above. Inital 10-day visit conducted on 11/04/24. LPA met with Administrator, presented official CDSS badge identification, and reason for the visit was disclosed.

At 10:20 am, LPA conducted a physical plant tour; no health and safety issues were observed.

To investigate the allegation, LPA received Facility resident roster, and staff roster. Between10:40 am and 11:25 am, LPA reviewed Resident 1's (R1) file, and documents relevant to the investigation. Between 12:10 pm and 1:45 pm, LPA observed R1, their bedroom, interviewed staff and residents.

[LIC 9099C]-Continued

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2025

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-20241029123550

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: 12/04/2025

NARRATIVE

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Allegation: Staff does not ensure resident receives adequate food service. Reporting Party (RP) alleges that Resident#1 (R1) is not adequately provided meals by staff and, as a result, R1 is losing weight.
During today's visit, LPA observations revealed the following: Today's menu consisted of chicken dumpling soup, orange chicken with rice, vegetable egg roll, and coconut cake. LPA observed R1 eating in the facility dining room; R1 appeared in good spirits, smiling and conversing with other residents and staff.
LPA conducted interviews with four (4) out of a total thirty (30) residents. All four (4) residents interviewed stated enjoying the meals provided by staff.

Based on the information LPA obtained through observation, and interviews, It cannot be proven that R1 is not provided meals by staff. Therefore, the allegation is deemed unsubstantiated at this time.

Allegation: Facility is not kept clean and sanitary. Reporting Party (RP) alleges that Resident#1 (R1's) room and restroom are not properly cleaned and sanitized, and that restroom often contains feces and urine stains.
During today's visit, LPA observations revealed the following: Both the facility in general, and R1's bedroom/restroom were found to be clean, without feces/urine stains, and having no odor.
LPA conducted interviews with four (4) out of a total of thirty (30) residents. All four (4) residents interviewed stated being satisfied with the consistency and level of cleanliness provided by staff.

Based on the information LPA obtained through observation, and interviews, It cannot be proven that R1's room and bedroom are not properly cleaned and sanitized by staff. Therefore, the allegation is deemed unsubstantiated at this time.

Allegation: Staff do not ensure that resident has clean linen. Reporting Party (RP) alleges that staff do not change Resident#1 (R1's) linens frequently.
During today's visit, LPA observations revealed the following: R1's bedsheets, pillowcases, and incontinence mattress pads were found to be clean, dry and free of odor. Facility's linen closet was examined and found to contain clean and odor free linens and towels provided to residents.

Based on the information LPA obtained through observation, and interviews, It cannot be proven that staff neglect provision of clean linen and towels to residents. Therefore, the allegation is deemed unsubstantiated at this time.
Exit interview conducted. A copy of the report was issued.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2025

LIC9099 (FAS) - (06/04)

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