197606838-11-13-2024-31-AS-APAA-DAYQJU-20241113111320

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197606838
Report Date: 11/13/2024
Date Signed: 11/13/2024 11:14:04 AM

Document Has Been Signed on 11/13/2024 11:14 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	TWIN PALMS		FACILITY NUMBER:	197606838
ADMINISTRATOR/ DIRECTOR:	JOHN MALLON		FACILITY TYPE:	740
ADDRESS:	19929 SEPTO STREET		TELEPHONE:	(818) 773-9291
CITY:	CHATSWORTH	STATE: CA	ZIP CODE:	91311
CAPACITY: 6	TOTAL ENROLLED CHILDREN: 0	CENSUS: 5	DATE:	11/13/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:30 AM
MET WITH:	John Maloon, Administrator		TIME VISIT/ INSPECTION COMPLETED:	11:40 AM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

At 8:30am, Licensing Program Analyst (LPA) Angela Panushkina arrived at the facility to conduct an unannounced annual inspection. Upon arrival, LPA met with Staff #1 (S1), who granted access to the facility. Administrator arrived shortly after and LPA explained the reason for the visit.

At 8:45am LPA conducted a tour of the physical plant and observed the following:

Kitchen: At approximately, 08:40am LPA toured the kitchen area and observed enough supplies of staple non-perishable for minimum 1 week and perishable for 2 days at the facility. All knives and sharps are observed to be locked in a kitchen drawer and inaccessible to residents.

Laundry: Laundry area is located by the kitchen and all detergents were kept locked and inaccessible to residents. LPA also observed a fire extinguisher that was last purchased on 06/24/24.

Medications: At approximately, 09:00am LPA observed medications are centrally stored and locked in the cabinet, in the kitchen and staff room and inaccessible to residents in care.

The garage: Facility has an attached garage that can be accessed from the kitchen. LPA observed the door kept locked and inaccessible to residents. Extra supplies and food were also observed.

Bedrooms: There are five (5) bedrooms designated for residents use and have sufficient lighting. All bedrooms are properly furnished, clean and have appropriate bedding and linens. Auditory alarms were tested and observed to be operational. Facility also has one (1) bedroom for live-in staff.

Bathrooms: At 09:20am LPA observed all bathrooms are clean and in good repair. Properly supplied with toilet papers, soap and paper towels. Continue on LIC809-C

Nichelle Gillyard	TELEPHONE: (818) 596-4341
Angela Panushkina	TELEPHONE: 747-230-3364
	DATE: 11/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: TWIN PALMS	FACILITY NUMBER: 197606838
	VISIT DATE: 11/13/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

LPA observed appropriate grab bar and had non-skid mat. All trash cans in bathrooms had fitted lids to protect from cross contamination.

Common Areas: The facility maintains a comfortable temperature at 75°F. The living room and dining area appeared clean and were properly furnished. No obstructions and or tripping hazards throughout the facility.

Smoke detectors/carbon monoxide. Dual smoke and carbon monoxide detectors were located throughout the facility, and at 9:25am they were tested and observed to be operational.

Outside areas: At approximately, 09:30am LPA toured the outside area of the facility. LPA observed appropriate outdoor furniture, with a covered shaded area for clients. LPA discussed the importance of maintaining the care and supervision to meet the needs of residents. There are no bodies of water.

Between 09:40am to 11:00am, LPAs reviewed records of five (5) clients and two (2) staff. Client and staff records appeared to be complete and updated.

Administrative: LPA collected Certificate of Liability Insurance, Administrator Certificate and LIC500.

No citations issued during this visit.

Exit interview conducted. Copy of report emailed to Licensee.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 11/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2024

LIC809 (FAS) - (06/04)

Page: 2 of 2