197607361-6-30-2026-31-AS-NGID-DVQP5E-20260706110034

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607361
Report Date: 06/30/2026
Date Signed: 06/30/2026 03:20:59 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
06/22/2026 and conducted by Evaluator Angela Panushkina

COMPLAINT CONTROL NUMBER: 31-AS-20260622125413

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:	06/30/2026
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Fernando Efable, Staff		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff falsified documents

INVESTIGATION FINDINGS:

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At 1:00pm, Licensing Program Analysts (LPAs), Angela Panushkina and Huma Rahimi conducted an unannounced visit in response to the above-mentioned allegation. LPAs met with the Staff #1 (S1), who granted access to the facility. Administrator was contacted and LPAs explained the reason for the visit. LPAs were informed that the Administrator is not able to come and designated S1 to sign the report.

At 1:10pm, LPAs requested resident and staff roster. Between 1:30pm – 2:30pm, LPAs conducted an interview with the Administrator and two (2) staff members.

It was alleged that Resident 1 (R1) fell on 10/28/25, Staff 1 (S1) failed to call 911, and Administrator, John Mallon, forged S1’s signature on the incident report to avoid a citation from Community Care Licensing Division (CCLD). To investigate this allegation, LPA interviewed the Administrator who denied any forgery and stated he himself signed the report.
Continue on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2026

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-20260622125413

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: 06/30/2026

NARRATIVE

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The Administrator acknowledged the fall occurred and stated that after reviewing video footage on 10/30/25, R1’s responsible party was notified and 911 was called. Two (2) staff interviewed informed LPAs they had not seen any signature forging and stated that when incidents occur, they call 911, notify the Administrator, and record detailed notes in the log. The log does not require staff signatures. LPAs reviewed facility’s incident log and confirmed that staff signatures are not required. Additionally, review of an incident report (submitted to CCLD on 11/03/25) showed only the Administrator’s typed name in both signature sections - no signatures from any staff were observed. Therefore, based on interviews and document review this allegation is deemed Unsubstantiated at this time.

No deficiency issued during today's visit.
Exit interview conducted and copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2026

LIC9099 (FAS) - (06/04)

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