197606838-2-2-2022-31-AS-NGID-CBVR4F-20220222114124

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606838
Report Date: 02/02/2022
Date Signed: 02/02/2022 10:54:17 AM

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
02/01/2022 and conducted by Evaluator Melissa Ruiz

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20220201133520

FACILITY NAME:	TWIN PALMS		FACILITY NUMBER:	197606838
ADMINISTRATOR:	JOHN MALLON		FACILITY TYPE:	740
ADDRESS:	19929 SEPTO STREET		TELEPHONE:	(818) 773-9291
CITY:	CHATSWORTH	STATE: CA	ZIP CODE:	91311
CAPACITY:	6	CENSUS: 4	DATE:	02/02/2022
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	John Mallon		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Neglect resulting in unwtiness fall and bodily injury.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

At 10:00 a.m. Licensing Progam Analysts (LPAs) Joscelyn Martinez and Melissa Ruiz conducted an unannounced initial complaint visit to this facility to investigate the above allegation.

LPAs were met by staff and later spoke to Administrator John Mallon telephonically. At 10:30 a.m., LPAs requested facility documents relevant to the investigation such as a current resident roster and LIC500. LPAs telephonically interviewed the Administrator and upon doing so, it was revealed that Resident #1 (R1) is not a resident at the facility nor has ever been a resident at this facility.

Due to this information, the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have dismissed the complaint. Since Administrator was not available at this time, Administrator designated staff Amorlina Comedia to sign the report. Report delivered. Exit interview conducted.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Melissa Ruiz	TELEPHONE: (818) 401-7980
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022

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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