197604333-12-15-2023-29-AS-KHEN-CYX2SV-20231227163946

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197604333
Report Date: 12/15/2023
Date Signed: 12/15/2023 03:02:25 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. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/20/2023 and conducted by Evaluator Martha Arroyo

COMPLAINT CONTROL NUMBER: 29-AS-20230920132237

FACILITY NAME:	BELLA ROSA PLACE, LLC.		FACILITY NUMBER:	197604333
ADMINISTRATOR:	MANJIT SINGH CHADHA		FACILITY TYPE:	740
ADDRESS:	23275 SYLVAN ST		TELEPHONE:	(818) 625-0517
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91367
CAPACITY:	6	CENSUS: 4	DATE:	12/15/2023
		UNANNOUNCED	TIME BEGAN:	01:20 PM
MET WITH:	Evangeline Zinampan		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility is in financial distress.
Staff did not provide a comfortable environment for residents.

INVESTIGATION FINDINGS:

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

Licensing Program Analysts (LPAs) Martha Arroyo and Emily Peraldi conducted a subsequent complaint visit to the facility to deliver findings for the above allegations. During today’s visit, LPA Arroyo met with staff, Evangeline Zinampan and explained the reason for the visit. Entrance interview.

During the initial visit on 09/26/2023, LPA Arroyo conducted a tour of the facility to ensure there are no health and safety hazards at 12:50 p.m., conducted interviews with the Licensee Representative, two staff, and two residents between 12:55 p.m. and 3:50 p.m., conducted a file review at 1:37 p.m., and obtained copies of pertinent documents relevant to the investigation. On 12/04/2023, LPA Arroyo conducted a tour of the facility to ensure there are no health and safety hazards at 11:50 a.m., conducted a telephonic interview with the Licensee Representative at 12:15 p.m., and conducted a resident file review at 12:55 p.m. and obtained copies of pertinent documents relevant to the investigation.

(Report Continued on LIC 9099C...)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Arroyo	TELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2023

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 2

Control Number 29-AS-20230920132237

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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: BELLA ROSA PLACE, LLC.	FACILITY NUMBER: 197604333
	VISIT DATE: 12/15/2023

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

(Report Continued from LIC 9099...)

It was alleged that facility is in financial distress. It was reported that the facility is not paying the utility bills in a timely manner causing certain services to be discontinued by the providers. Information and documents obtained and reviewed revealed that the facility was behind in paying the Spectrum bill which consists of television, internet, and telephone services. The Spectrum bill for October indicated the bill had a past due balance of $406 and the Spectrum bill for November indicated both the monthly bill and past due balance had been paid. Additionally, other documents reviewed included the property mortgage and SoCalGas invoices. Documents reviewed revealed that utility bills as well as the mortgage payments are being made. Interviews conducted with residents revealed that the television is on for the majority of the day and reported having no problems watching television, including their usual television shows. Furthermore, although the facility fell behind to pay the Spectrum bill, services at the facility were not discontinued at any time. Based on the information and documents obtained and reviewed, the Department does not have sufficient evidence to support the allegation of “facility is in financial distress”. Therefore, this allegation is deemed Unsubstantiated at this time.

It was also alleged that staff did not provide a comfortable environment for residents. It was reported that due to the facility not paying the utility bills, the residents were unable to watch television and there was no internet access. Information obtained during the course of the investigation revealed the facility was behind on the Spectrum bill which consisted of television, internet, and telephone services. Interviews conducted with residents revealed the television service have not stopped as they continue to watch television on a daily basis. Additionally, residents stated they were not aware if the facility was behind on the utility bills as the service for all utilities had not been discontinued at any time. Furthermore, residents stated living comfortably in the home and reported having no concerns while at the facility. Based on the information obtained during the course of the investigation, the Department does not have sufficient evidence to support the allegation of “staff did not provide a comfortable environment for residents.” Therefore, this allegation is deemed Unsubstantiated at this time.

Exit interview conducted. A copy of the report was provided.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Arroyo	TELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2