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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197604333
Report Date: 05/24/2024
Date Signed: 05/24/2024 10:25:44 AM

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
04/13/2023 and conducted by Evaluator Emily Peraldi
COMPLAINT CONTROL NUMBER: 29-AS-20230413144018
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:0CENSUS: 0DATE:
05/24/2024
UNANNOUNCEDTIME BEGAN:
08:52 AM
MET WITH:Pogos TofalyanTIME COMPLETED:
10:25 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Uncleared staff directing residents in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Emily Peraldi conducted an unannounced telephonic subsequent complaint visit at the facility today to deliver findings. At 8:53 a.m., LPA Peraldi called Licensee, Pogos Tofalyan and explained the reason for the phone call.

During the initial visit on 4/20/2023, between 10:03 a.m. and 2:02 p.m., LPA Christine Yee interviewed the Administrator at the time, Manjit Chadha, Staff #1 (S1), Staff #2 (S2) and six (6) residents. The LPA also conducted a file review at 1:15 p.m. On 04/18/2024, LPA Peraldi conducted an interview with S1 as a collateral visit at A'MORECARE HOME ASSISTED LIVING.

Continued LIC 9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily PeraldiTELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024
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 5
Control Number 29-AS-20230413144018
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: BELLA ROSA PLACE, LLC.
FACILITY NUMBER: 197604333
VISIT DATE: 05/24/2024
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
Regarding the allegation: Uncleared staff directing residents in care. On 04/13/2023, the Department received a complaint alleging that an uncleared, excluded individual was involved with residents’ care. It was alleged that the excluded individual had involvement in the placement and relocation of residents at the facility. During the initial visit, staff interviews denied the presence or involvement of the excluded individual. However, two (2) out of six (6) residents did state that the excluded individual goes to the facility and is involved in residents’ care. During the interview with S1 on 04/18/2024, S1 stated and confirmed that S1 would call the excluded individual for help regarding the care of residents. S1 denied that the excluded individual would physically go inside the facility, but S1 did state that S1 would call the excluded individual regarding the facility and residents. S1 did not go into detail of what the excluded individual’s main role was to the facility, however S1 described the excluded individual as an owner of the facility. Per interviews, the excluded individual was involved and was directing residents in care. Based on the information gathered during the course of the investigation, the preponderance of evidence standard has been met, therefore the above allegation is deemed Substantiated.

Per the California Code of Regulations, Title 22, Division 6, Chapter 8, California Health and Safety Code the following deficiencies were observed and cited during the visit (See 9099-D). A $500 immediate civil penalty is assessed today.

Exit interview conducted. A copy of the report and appeal rights was issued to the former licensee mail for signature.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily PeraldiTELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 29-AS-20230413144018
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: BELLA ROSA PLACE, LLC.
FACILITY NUMBER: 197604333
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/24/2024
Section Cited
HSC
1569.58(a)(2)
1
2
3
4
5
6
7
§1569.58(a)(2) The department may prohibit any person from being … an administrator … and ... allowing contact with clients of a licensed facility… who has done … the following: (2) Engaged in conduct that is inimical to the health ...
1
2
3
4
5
6
7
No plan of correction, facility closed on 02/08/2024.
8
9
10
11
12
13
14
This requirement is not met as evidenced by:
Based on interviews, the Licensee did not comply with the section cited above, as an excluded individual had involvement with residents’ care which poses an immediate health,safety and personal rights risk to residents 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.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily PeraldiTELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
04/13/2023 and conducted by Evaluator Emily Peraldi
COMPLAINT CONTROL NUMBER: 29-AS-20230413144018

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:0CENSUS: 0DATE:
05/24/2024
UNANNOUNCEDTIME BEGAN:
08:52 AM
MET WITH:Pogos TofalyanTIME COMPLETED:
10:25 AM
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) Emily Peraldi conducted an unannounced telephonic subsequent complaint visit at the facility today to deliver findings. At 8:53 a.m., LPA Peraldi called Licensee, Pogos Tofalyan and explained the reason for the phone call.

During the initial visit on 4/20/2023, between 10:03 a.m. and 2:02 p.m., LPA Christine Yee interviewed the Administrator at the time, Manjit Chadha, Staff #1 (S1), Staff #2 (S2) and six (6) residents. The LPA also conducted a file review at 1:15 p.m. On 04/18/2024, LPA Peraldi conducted an interview with S1 as a collateral visit at A'MORECARE HOME ASSISTED LIVING.

Continued LIC 9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily PeraldiTELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20230413144018
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: BELLA ROSA PLACE, LLC.
FACILITY NUMBER: 197604333
VISIT DATE: 05/24/2024
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
Regarding the allegation: Illegal eviction. On 04/13/2023, the Department received a complaint alleging that Resident #1 (R1) was told by an excluded individual that R1 will be moving out of the facility or be transferred to the hospital. Interview with R1 revealed that the excluded individual went to the facility to tell R1 that R1 was going to be taken away. Interview with S1 conducted on 04/18/2024, revealed that R1 got sick and was hospitalized. S1 stated that R1 did not return to the facility. S1 stated that when R1 got sick, S1 called the excluded individual and was instructed to call 911 for R1. S1 did not give LPA Peraldi dates or further details regarding R1’s hospitalization. LPA Peraldi conducted a file review on 05/23/2024 and did not find any records or documentation regarding R1’s hospitalization in 2023. LPA Peraldi could not confirm if R1 was sick and agreed to go to the hospital or if R1 was forced to go to the hospital. The information obtained during the investigation did not include evidence sufficient to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time.

Exit interview conducted. A copy of the report was issued to the former licensee mail for signature.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily PeraldiTELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5