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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610743
Report Date: 12/01/2025
Date Signed: 12/01/2025 01:43:26 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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
11/24/2025 and conducted by Evaluator Mariana Agban
COMPLAINT CONTROL NUMBER: 31-AS-20251124094449
FACILITY NAME:MAYALL HOMEFACILITY NUMBER:
197610743
ADMINISTRATOR:LORA PANAFACILITY TYPE:
735
ADDRESS:19638 MAYALL ST.TELEPHONE:
(818) 626-9122
CITY:NORTHRIDGESTATE: CAZIP CODE:
91324
CAPACITY:4CENSUS: 2DATE:
12/01/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Lora Pana- AdministratorTIME COMPLETED:
01:55 PM
ALLEGATION(S):
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Staff did not adhere to residents IPP plan
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mariana Agban conducted an unannounced initial complaint visit to investigate the allegation mentioned above. LPA met with Administrator Lora Pana and explained the purpose of the visit. A tour of the physical plant was conducted to ensure that client health and safety were being maintained and that the facility remained in compliance with Title 22 Regulations. LPA requested copies of the Staff Roster, Client Roster, Client#1 (C1)'s IPP, and other documents pertinent to the investigation.

Allegation: Staff did not adhere to residents IPP plan
It was reported that facility staff administered the antipsychotic medication Haloperidol 2 mg on November 2, 2025, after receiving verbal approval from C1’s parent, who does not hold medical conservatorship. Interviews with the Administrator, S2, and S3 revealed that the medication was administered in response to C1’s behavior. The Administrator confirmed that staff relied solely on the parent’s consent and did not obtain approval from the North Los Angeles County Regional Center (NLACRC).
(Continue on 9099C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2025
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 3
Control Number 31-AS-20251124094449
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: MAYALL HOME
FACILITY NUMBER: 197610743
VISIT DATE: 12/01/2025
NARRATIVE
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Interview with Staff #2 (S2) revealed that facility staff attempted to contact C1’s Consumer Service Coordinator but did not receive a response. S2 stated that, due to the escalation of C1’s behavior, S2 instructed S3 to administer the medication. Interview with S3 confirmed that the medication was administered as directed by S2. Record review of C1’s Individual Program Plan (IPP) indicated that the North Los Angeles County Regional Center (NLACRC) is C1’s court appointed medical conservator.

Based on the information obtained, the allegation is deemed Substantiated at this time. Staff did not adhere to C1’s IPP.



Exit interview conducted. Citation issued. Copy of this report signed and delivered.  




SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20251124094449
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: MAYALL HOME
FACILITY NUMBER: 197610743
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/01/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/01/2025
Section Cited
CCR
85078(a)(1)
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Responsibility for Providing Care and Supervision- The licensee shall provide those services identified in the client's needs and services plan as necessary to meet the client's needs. This requirement was not met as evidenced by:
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The administrator had conducted in-service training for all facility nurses to adhere to all clients' Individual Program Plans. A copy of the in-service training was obtained during the visit.
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Facility staff administered antipsychotic medication Haloperidol 2 mg, without receiving NLACRC's approval as indicated on C1's IPP. This posed an immediate health & safety risk to the residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3