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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607361
Report Date: 01/05/2024
Date Signed: 02/06/2024 09:08:34 AM

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
12/05/2022 and conducted by Evaluator Abeye Duguma
COMPLAINT CONTROL NUMBER: 31-AS-20221205172017
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:
01/05/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Astrid BautistaTIME COMPLETED:
04:50 PM
ALLEGATION(S):
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Staff are not providing night time supervision to the residents
INVESTIGATION FINDINGS:
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This is an ammended report to the complaint investigation conducted by Licensing Program Analyst (LPA) Abeye Duguma pertaining to the above allegation. The findings were unsubstantiated but erroneously marked substantiated. Licensee, John Mallon, designated staff Astrid Bautista to sign and accept the report.

LPA Abeye Duguma conducted an unannounced subsequent complaint visit to this facility to investigate the above allegation. LPA met with caregiver, John Mallon, and explained the reason for the visit.
--- Staff are not providing night time supervision to the residents.
It was alleged that the facility does not have awake staff member 24/7. To investigate the allegation, on 12/14/2022 at around 3:15 PM, LPA Martinez interviewed two (02) staff and on 01/05/2024, LPA Duguma interviewed two (02) staff from 10:30 AM – 11:30 AM and three (03) out of six (06) residents from 3:30 PM – 4:30 PM. During interviews with staff, Staff #1 (S1) stated they are live-in staff, work one twelve (12) hour shift per day from 7:30 AM - 7:30 PM and on-call should any residents need assistance overnight.
(CONT. on LIC9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2024
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-20221205172017
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: 01/05/2024
NARRATIVE
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Staff #1 (S1) added that they check on the residents every two (02) hours. Staff #2 (S2) stated S1 is the staff that works at night and is a wake staff. S2 added that S1 usually works from 9:00 PM to 7:00 AM. Staff #3 (S3) stated that they work from 7:30 AM - 7:30 PM but are on-call to tend to any residents that need assistance overnight and check on residents every two hours. During interviews with residents, all residents stated staff are available overnight, should they need assistance. LPA was unable to interview three (03) out of (06) six residents.

Based on interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

No other health and safety hazards were noted during the visit.

An exit interview was conducted, and a copy of the report was issued.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 01/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2