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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610370
Report Date: 09/29/2026
Date Signed: 09/29/2026 02:11:39 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
06/15/2026 and conducted by Evaluator Raymond Comer
COMPLAINT CONTROL NUMBER: 31-AS-20260615095803
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:
09/29/2026
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Jennifer Rivera, Business Office Manager (BOM)TIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff are not meeting resident's diabetic needs.
INVESTIGATION FINDINGS:
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On 9/29/26, Licensing Program Analyst, (LPA) Raymond Comer, arrived to conduct a subsequent visit regarding the allegation listed above. On 06/17/26, LPA Antonia Alvizar-Ettima conducted the initial complaint visit and at that time, requested and received the resident/staff roster and conducted a physical plant tour; no health and safety issues were observed at that time.

Today, LPA Comer met with facility Business Office Manager (BOM), presented official CDSS badge identification, and reason for the visit was disclosed. Between 12:30pm and 12:50pm, LPA obtained and reviewed Facility Resident roster, Personnel roster, Resident#1s (R1's) Physician Report, Appraisal/Needs & Services Plan, Medication Administration Record, (MAR) and other pertinent documentation. Between 1:00pm and 2:15pm, LPA Comer spoke with the Administrator, one (1) Staff, and five (5) residents.

[LIC9099C] Continued-
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2026
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 2
Control Number 31-AS-20260615095803
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: 09/29/2026
NARRATIVE
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Allegation: Staff are not meeting resident's diabetic needs. It was alleged that on the evenings of 6/11/26 and 6/12/26, Staff #2 (S2) did not provide Resident #1's (R1) medication, via injection.

LPA Comer's interviews with the Administrator and one (1) staff revealed the following: Both refute the allegation, stating to LPA that staff provide medications assistance/administration on a consistent basis.
LPA Comer's review of records revealed that R1 is able to perform their own glucose testing, and administer their own medication injections, with some assistance by staff. On 6/11/26 and 6/12/26, records show R1 was provided their medication for injection, as prescribed. Additionally, a review of the staff schedule shows Staff#2 (S2) was not scheduled to work at the facility on 6/12/26.
LPA interviews with five (5) out of a total fifty-four (54) residents revealed the following: Four (4) out of five (5) residents interviewed stated to LPA that they have no issues staff medications assistance and that staff provide such assistance on a consistent basis.

Based on LPA's interviews with Staff, Residents, and records review, there was insufficient evidence to establish that staff failed to meet resident's diabetic needs. Therefore, this allegation is deemed Unsubstantiated at this time.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2