<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850262
Report Date: 12/22/2023
Date Signed: 12/22/2023 04:22:47 PM


Document Has Been Signed on 12/22/2023 04:22 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:QUORA CAREFACILITY NUMBER:
195850262
ADMINISTRATOR:GOCHIN, RHODAFACILITY TYPE:
740
ADDRESS:22806 CALIFA STREETTELEPHONE:
(747) 230-8689
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91367
CAPACITY:6CENSUS: 4DATE:
12/22/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Pogos Tofalyan, applicantTIME COMPLETED:
04:30 PM
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
Licensing Program Analysts (LPAs) Emily Peraldi and Martha Arroyo conducted an unannounced visit to this location along with Long Term Care Ombudsman Ginger Perini, Adult Protective Services Social Worker Joycelynn Mantuano, and Los Angeles City Fire Inspector Linsay Pellegrini for the purpose of notifying applicant, Pogos Tofalyan, that the licensure application for this property has been denied by Community Care Licensing’s (CCL) Centralized Applications Bureau, effective December 19, 2023. The applicant arrived at 2:20 p.m. and met with LPAs at this property. At 2:22 p.m., Los Angeles City Fire Captain Escobedo arrived at the property.

At 1:42 p.m., the LPAs spoke with Pogos Tofalyan over the telephone. During the time of the visit, Pogos Tofalyan acknowledged receiving the Department’s application denial letter that was sent via certified mail on December 19, 2023. During the telephonic conversation with the applicant, Pogos Tofalyan he stated that he will meet the LPAs at the property. In addition, Pogos Tofalyan was informed that a second Notice of Operation in Violation of Law (NOVL) will be served during today’s visit. An initial NOVL was served to Pogos Tofalyan on December 8, 2023. During today’s visit, LPAs provided a copy of the Department’s application denial letter for this property.

Per the NOVL, Pogos Tofalyan must relocate all individuals requiring care and supervision by January 5, 2023. It was also explained to Pogos Tofalyan that per Health and Safety Code 1569.16(b), re-submitting an application will not correct today’s citation, as an applicant does not have the right to re-apply for licensure for one year after the Department’s application denial. The applicant, Pogos Tofalyan was informed that a retroactive civil penalty of $100 per day per tenant shall be assessed on the 16th day from the date of the notice of Operation in Violation of the Law (December 22, 2023) for the operation of an unlicensed facility. If the operator has not ceased operation within 15 calendar days of the issuance of this notice. On the 16th day from the notice, if the unlicensed operation continues to operate, a $200 per tenant per day will be assessed until the operation ceases. Continued on LIC 809-C
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily PeraldiTELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:
DATE: 12/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/22/2023
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 3


Document Has Been Signed on 12/22/2023 04:22 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364


FACILITY NAME: QUORA CARE
FACILITY NUMBER: 195850262

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/22/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/05/2024
Section Cited
HSC
1569.10.

1
2
3
4
5
6
7
HSC: 1569.10. RCFE; license or permit; necessity: No person,... or corporation... shall operate,…manage,…or maintain a residential facility for the elderly in this state without a current valid license ...This requirement was not met as evidenced by:
1
2
3
4
5
6
7
The Applicant agreed and acknowledged that he shall relocate all individuals requiring care and supervision by January 5, 2023. The Applicant also agreed to provide proof of each individuals relocation site. Re-submitting an application will not correct today’s citation, as an applicant
8
9
10
11
12
13
14
Based on interviews and record review, the Applicant did not comply with the section cited above as four (4) out of four (4) individuals require assistance with aspects of care in activities of daily living, which poses an immediate health and safety risk to individuals in care.
8
9
10
11
12
13
14
does not have the right to re-apply for licensure for one year after the Department’s application denial.
All four (4) residents were transported to the hospital for further evaluation. Plan of Correction met.

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily PeraldiTELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:
DATE: 12/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/22/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: QUORA CARE
FACILITY NUMBER: 195850262
VISIT DATE: 12/22/2023
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
At 1:39 p.m., LPAs gained entry onto the property and observed four (4) individuals residing at the facility that require care and supervision. Upon arrival, the LPAs observed a newly admitted resident. Based on assessment, Emergency Medical Services (EMS) personnel was called, and all four (4) residents were transported to the hospital for further evaluation.

Exit interview conducted with applicant, Pogos Tofalyan. A copy of this report and a copy of the Department’s application denial letter was provided to Pogos Tofalyan. A copy of the NOVL was also provided.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily PeraldiTELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3