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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197606838
Report Date: 11/13/2024
Date Signed: 11/13/2024 11:14:49 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 PALMSFACILITY NUMBER:
197606838
ADMINISTRATOR/
DIRECTOR:
JOHN MALLONFACILITY TYPE:
740
ADDRESS:19929 SEPTO STREETTELEPHONE:
(818) 773-9291
CITY:CHATSWORTHSTATE: CAZIP CODE:
91311
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
11/13/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:John Mallon, Administrator TIME VISIT/
INSPECTION COMPLETED:
11:40 AM
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At 08:30am, Licensing Program Analyst (LPA) Angela Panushkina conducted an unannounced Case Management Visit. LPA met with Staff #1 (S1), who granted access to the facility. Administrator arrived shortly after and LPA explained the reason for the visit.

On 02/29/2024, a Noncompliance Conference was held at the Regional Office (RO) with the Administrator and concerns from Complaints #31-AS-20240110162135 and #31-AS-20230605162033 were addressed. At that time, Regional Manager (RM) and Licensing Program Manager (LPM) advised the Administrator to conduct thorough pre-admission appraisals and complete staff training.

The purpose of todays visit is to review all resident and staff files for an accuracy. LPA was informed that the facility currently has five (5) residents. Facility also has two (2) staff members and LPA checked the Licensing Information System (LIS) and observed that both staff members are associated with this facility and the fingerprints are cleared.

Resident Files: At 9:45am team conducted resident and staff records review. The following was observed. Five (5) out of five (5) resident file were available and LPA observed all files were signed and complete.

Staff Files: Administrator stated that the facility currently has four (4) staff members. LPA observed two (2) out of four (4) staff members present during today's visit. LPA conducted review of staff records and observed all required training along with staff signed and complete records on file.

No deficiency cited.



Exit interviewed conducted and copy of this report signed and delivered.
Nichelle GillyardTELEPHONE: (818) 596-4341
Angela PanushkinaTELEPHONE: 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)
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