197604333-4-29-2022-29-AS-JAPL-CE2UZR-20220502160154

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197604333
Report Date: 04/29/2022
Date Signed: 04/29/2022 11:57:05 AM

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
04/15/2022 and conducted by Evaluator Elsie Campos

COMPLAINT CONTROL NUMBER: 29-AS-20220415133828

FACILITY NAME:	BELLA ROSA PLACE, LLC.		FACILITY NUMBER:	197604333
ADMINISTRATOR:	JOLANTA ROBERTS		FACILITY TYPE:	740
ADDRESS:	23275 SYLVAN ST		TELEPHONE:	(818) 625-0517
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91367
CAPACITY:	6	CENSUS: 6	DATE:	04/29/2022
		UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Feesperanz Pineda and Jolanta Roberts		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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The administrator/owner has blocked the resident from calling him.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elsie Campos conducted an unannounced subsequent visit to the facility today. The LPA met with caregiver Feesperanz Pineda and explained the reason for the visit. There were three staff and six residents present. The Administrator Jolanta Roberts arrived at the facility shortly thereafter.

Today, the LPA, interviewed staff at 10:30 a.m. and conducted a brief facility tour at 10:32 a.m.

Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie Campos	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20220415133828

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: 04/29/2022

NARRATIVE

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Regarding the allegation: The administrator/owner has blocked the resident from calling him.

The complainants concern is that Resident #1 (R1) was blocked from calling the administrator/owner. During the investigation, interview with R1 confirmed that they were attempting to contact an administrator named Gbolabo ‘Labo’ Folayan, who since January 2019 has been excluded from having any authority to operations at any facility. R1 was under the impression that Labo was the administrator because it’s common knowledge and confirmed that Labo has been seen multiple times at the facility and acts like he is the boss. However, staff and resident interviews confirmed that the facility administrator is in fact Jolanta Roberts and they have not been blocked from calling her. Staff negated claims that any of the residents have been told to contact Labo or that he is the administrator. Based on the investigation there is insufficient evidence to support the claim, the administrator/owner has blocked the resident from calling him. This allegation is deemed Unsubstantiated at this time.

No deficiencies cited regarding the complaint.

Exit interview conducted and a copy of the report was issued.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie Campos	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2022

LIC9099 (FAS) - (06/04)

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