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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607361
Report Date: 10/19/2022
Date Signed: 10/19/2022 04:11:23 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
10/11/2022 and conducted by Evaluator Joscelyn Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20221011142733
FACILITY NAME:ROYAL PALMSFACILITY NUMBER:
197607361
ADMINISTRATOR:NATALIE MALLONFACILITY TYPE:
740
ADDRESS:20548 GERMAIN STREETTELEPHONE:
(818) 772-7153
CITY:CHATSWORTHSTATE: CAZIP CODE:
91311
CAPACITY:6CENSUS: 6DATE:
10/19/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:John Mallon TIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Staff threatens a resident with eviction while in care
Staff verbally abuses a resident while in care
Staff is mistreating a resident while in care
INVESTIGATION FINDINGS:
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On 10/19/22 Licensing Program Analyst (LPA Joscelyn Martinez arrived at the facility to conduct an unannounced complaint investigation visit. Upon arrival LPA met with staff and then with administrator John Mallon. The purpose of the visit was conducted.

Allegation: Staff threatens a resident with eviction while in care
It is alleged that staff threaten R1 with an eviction due to R1 complaints. To investigate this allegation, LPA conducted interview with R1 and administrator. Interview with R1 revealed that R1 has not received a letter of eviction. R1 stated the administrator verbally told R1 they will be evicted. Interview with administrator revealed R1 refused to sign an itemized form that needs to be submitted to R1’s insurance every end-of-month in order to receive payment for R1’s board and care. Administrator stated they told R1 if the form is not signed the facility will not get paid and can warrant a cause for eviction in the future. Administrator stated the facility has never issued an eviction or has threaten evicting R1 due retaliation. Based on interviews this allegation is deemed Unsubstantiated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Joscelyn Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2022
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-20221011142733
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: ROYAL PALMS
FACILITY NUMBER: 197607361
VISIT DATE: 10/19/2022
NARRATIVE
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Allegation 2: Staff verbally abuses a resident while in care
Allegation 3: Staff is mistreating a resident while in care

It is alleged that residents are being verbally abused and mistreated by staff. To investigate this allegation LPA conducted interview with three (3) residents and five (5) staff members. LPA attempted to interview an additional three residents but due to their medical condition the residents were unable to provide answers. Interviews with residents revealed two (2) out of three residents (3) stated they are not mistreated nor verbally abused by staff. Interviews with five (5) out of five (5) staff members revealed they have not heard any complaints from residents stating they are being verbally abused nor mistreated. All five (5) staff stated they have not witness any other staff verbally abusing or mistreating the residents. Based on interviews these allegations are deemed Unsubstantiated.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Joscelyn Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2