195850562-9-4-2025-29-AS-KHEN-DLYSCL-20250929134544

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850562
Report Date: 09/04/2025
Date Signed: 09/04/2025 01:06:51 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

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

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/23/2025 and conducted by Evaluator Angela Barutyan

COMPLAINT CONTROL NUMBER: 29-AS-20250723152952

FACILITY NAME:	A'ONE VILLA ASSISTED LIVING		FACILITY NUMBER:	195850562
ADMINISTRATOR:	SINGH, JAGDEEP		FACILITY TYPE:	740
ADDRESS:	23511 BERDON STREET		TELEPHONE:	(818) 704-0012
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91367
CAPACITY:	6	CENSUS: 0	DATE:	09/04/2025
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Jagdeep Singh		TIME COMPLETED:	01:10 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Illegal Eviction

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct a subsequent complaint investigation at 10:30AM. Upon arrival, LPA met with construction workers who called Administrator Granie Pangilinan at 10:33AM. LPA called Licensee Jagdeep Singh at 10:36AM who arrived at 12:58PM. Administrator was unable to be present during the visit. Entrance interview conducted.

During today’s visit, LPA Barutyan interviewed the Licensee telephonically and observed the facility currently under construction with no residents. During the initial visit on 07/29/2025, LPA conducted a physical plant tour and observed no residents residing at the facility, conducted interviews, reviewed and obtained copies of pertinent documents relevant to the investigation, and discussed allegation with Licensee telephonically.

Report Continued on LIC 9099-C.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025

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 29-AS-20250723152952

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: A'ONE VILLA ASSISTED LIVING	FACILITY NUMBER: 195850562
	VISIT DATE: 09/04/2025

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

It was alleged that Resident #1 (R1) was issued an unlawful eviction notice on 06/30/2025. LPA reviewed the eviction notice dated 06/30/2025 which states, “This letter is to inform you that the ownership of A 'One Villa Assisted Living is in the process of being transferred to new management. As part of the Change of Ownership procedure, the new members are required to apply to the California Department of Social Services (CDSS). Due to this transition, we are issuing a 30-day notice for you to vacate the facility, effective June 30, 2025. We kindly ask that you arrange to relocate by July 30, 2025, to accommodate this required process.” R1 moved out of the facility on 07/25/2025. Per regulation, a change of ownership (CHOW) does not meet eviction criteria. A CHOW for a facility with admitted residents does not require current residents to be relocated; the same residents can be retained by the prospective new licensee. The facility also did not notify the Department of the issued eviction notice, which was cited on a separate report, and the eviction notice did not include statements required by the Health and Safety Code, including: a statement informing residents of their right to file a complaint with the licensing agency including contact information for the licensing office with whom the licensee normally conducts business, and the State Long Term Care Ombudsman office; AND the exact statement as specified in Health and Safety Code Section 1569.683(a)(4) regarding the facility’s requirement to file an unlawful detainer action in superior court should a resident remain after the effective date of the eviction. Interviews conducted with R1’s responsible party and staff confirmed that a corrected notice was not issued and that the reason for eviction was due to the CHOW and not any of the valid reasons that meet eviction criteria, such as nonpayment of rent or failure of the resident to comply with general policies of the facility. Based on interview and record review, the allegation “Illegal Eviction” is deemed SUBSTANTIATED at this time.

The following deficiency was observed (See LIC 9099-D) and cited from the California Code of Regulations, Title 22 and/or California Health and Safety Code. Licensee was informed that failure to correct the deficiency may result in civil penalties.

Exit interview conducted. Appeal rights and a copy of the report were provided.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 29-AS-20250723152952

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: A'ONE VILLA ASSISTED LIVING	FACILITY NUMBER: 195850562
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/04/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/11/2025 Section Cited CCR 87224(a)	1 2 3 4 5 6 7	87224 Eviction Procedures (a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5)... This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Resident relocated on 07/25/2025. Licensee agreed to issue a refund to the resident/resident’s responsible party for the remaining days of July 2025 in which the resident was not residing at the facility and send proof to CCLD by the due date.
	8 9 10 11 12 13 14	Based on record review and interview, the licensee did not comply with the section cited above as a resident was issued an eviction notice for reasons not listed in eviction criteria which posed a potential health, safety, and personal rights risk to persons in care.	8 9 10 11 12 13 14
	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.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 3