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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197604333
Report Date: 01/25/2024
Date Signed: 01/25/2024 04:00:30 PM


Document Has Been Signed on 01/25/2024 04:00 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:BELLA ROSA PLACE, LLC.FACILITY NUMBER:
197604333
ADMINISTRATOR:MANJIT SINGH CHADHAFACILITY TYPE:
740
ADDRESS:23275 SYLVAN STTELEPHONE:
(818) 625-0517
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91367
CAPACITY:6CENSUS: 4DATE:
01/25/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Ashley RamirezTIME COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Martha Arroyo and Emily Peraldi conducted an unannounced visit to this location along with Long Term Care Ombudsman Ginger Perini 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 January 23, 2024. Entrance interview.

At 3:17 p.m., LPAs gained entry onto the property and observed four (4) individuals residing at the facility that require care and supervision. The applicant was not able to meet with LPAs at this property. At 3:40 p.m., LPAs toured the property to ensure there were no health and safety concerns.
At 3:31 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 January 23, 2024. 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 15, 2023. During today’s visit, LPAs provided a copy of the Department’s application denial letter for this property. Per the NOVL, Mr. Tofalyan must relocate all individuals requiring care and supervision by February 14, 2024. It was also explained to Mr. 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.

Report was reviewed with staff and a copy of this report was emailed to Mr. Tofalyan.
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha ArroyoTELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:
DATE: 01/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/25/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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