197607361-8-30-2023-31-AS-NGID-CWWRZQ-20231024132814

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607361
Report Date: 08/30/2023
Date Signed: 08/30/2023 02:58:41 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
08/24/2023 and conducted by Evaluator Angela Panushkina

COMPLAINT CONTROL NUMBER: 31-AS-20230824085032

FACILITY NAME:	ROYAL PALMS		FACILITY NUMBER:	197607361
ADMINISTRATOR:	NATALIE MALLON		FACILITY TYPE:	740
ADDRESS:	20548 GERMAIN STREET		TELEPHONE:	(818) 772-7153
CITY:	CHATSWORTH	STATE: CA	ZIP CODE:	91311
CAPACITY:	6	CENSUS: 6	DATE:	08/30/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	John Mallon, Administrator		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff do not provide toileting assistance to residents in care
Staff do not provide transportation assistance to residents in care

INVESTIGATION FINDINGS:

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At 9:00am Licensing Program Analyst (LPA) Angela Panushkina conducted an unannounced complaint visit to investigate the above stated allegations. LPA met with Staff #1 (S1) who granted access to the facility. Administrator arrived shortly after and LPA explained the reason for the visit.

During course of the investigation, interviews and record review were made. At 9:20am, LPA requested resident and staff roster. At 9:30am, LPA requested copies of pertinent information which include, but not limited to Admission Agreement, Physician’s report, Appraisal Needs and Services Plan, Resident Appraisal and Staff training, etc., relevant to the investigation. At approximately 9:40am, LPA conducted a physical plant tour, to ensure health and safety of the residents are protected and physical plant is in compliance with Title 22 Regulations. Between 10:00am – 12:00pm, LPA interviewed the Administrator, two (2) staff members and five (5) out of six (6) residents.

Continue on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

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-20230824085032

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: 08/30/2023

NARRATIVE

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Allegation: Staff do not provide toileting assistance to residents in care.

Interviews with the Administrator and two (2) staff revealed that all residents are being changed at least three (3) times per day and or as needed. Moreover, LPA was informed that all residents are verbal, and when they ask for toileting needs, an immediate assistance is provided by the staff. LPA was able to interview all residents regarding this allegation. Five (5) out of six (6) residents interviewed confirmed that they are assisted to the restroom, whenever they request to be taken and that this has not been a concern. In addition, all residents do require assistance with diapers/pull-ups and five (5) residents state that the staff have never left them unclean. Lastly, LPA did not observe any strong smells of urine throughout the facility.

Allegation: Staff do not provide transportation assistance to residents in care

Interview with the Administrator revealed the facility does not have a designated vehicle for transportation. If the family is unable to provide transportation the facility will arrange transportation through a third-party provider such as World Trans, Access and other program vehicles at a cost to be covered by the resident or residents' insurance. Furthermore, according to the Administrator, as a last resort he has driven residents to medical appointments as well. Five (5) out of six (6) residents interviewed today reported no issues with obtaining or asking for transportation to medical appointments. Resident's that stated they have had family assist them with transportation needs noted it does not happen often and has not been an issue or concern. Lastly, record review revealed that the arrangement for transportation, in an Admission Agreement, is under the “Optional Services” for an additional monthly fee.

Based on inspection, observation and interviews there is no sufficient evidence to support the allegation. Therefore, the allegation is Unsubstantiated at this time.

Exit interview conducted and copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

LIC9099 (FAS) - (06/04)

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