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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610195
Report Date: 12/03/2025
Date Signed: 12/03/2025 12:06:41 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/01/2025 and conducted by Evaluator Gina Saucedo
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20251201104955
FACILITY NAME:JRBELLA HOME FOR THE ELDERLYFACILITY NUMBER:
197610195
ADMINISTRATOR:TUMALIUAN, NESTORFACILITY TYPE:
740
ADDRESS:17100 CALAHAN STREETTELEPHONE:
(818) 524-8613
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY:6CENSUS: 5DATE:
12/03/2025
UNANNOUNCEDTIME BEGAN:
09:34 AM
MET WITH:Nestor Tumaliuan, AdministratorTIME COMPLETED:
12:10 PM
ALLEGATION(S):
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Staff is overcharging a resident
INVESTIGATION FINDINGS:
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On 12/03/25, at 9:25am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, initial complaint visit and was greeted by Administrator, Nestor Tumaliuan. LPA explained the purpose of this visit was to gather information, interview staff and residents and deliver findings for this complaint.

On 12/03/25, at 9:35am, LPA Saucedo asked for the census, staff, and client rosters. On 12/03/25, at 9:55am, LPA Saucedo conducted a physical tour, interviewed staff and attempted to interview residents.

LIC 9099C-continued
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2025
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/01/2025 and conducted by Evaluator Gina Saucedo
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20251201104955

FACILITY NAME:JRBELLA HOME FOR THE ELDERLYFACILITY NUMBER:
197610195
ADMINISTRATOR:TUMALIUAN, NESTORFACILITY TYPE:
740
ADDRESS:17100 CALAHAN STREETTELEPHONE:
(818) 524-8613
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY:6CENSUS: 5DATE:
12/03/2025
UNANNOUNCEDTIME BEGAN:
09:34 AM
MET WITH:Nestor Tumaliuan, AdministratorTIME COMPLETED:
12:10 PM
ALLEGATION(S):
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9
Staff unlawfully evicted a resident
INVESTIGATION FINDINGS:
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13
On 12/03/25, at 9:25am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, initial complaint visit and was greeted by Administrator, Nestor Tumaliuan. LPA explained the purpose of this visit was to gather information, interview staff and residents and deliver findings for this complaint.

On 12/03/25, at 9:35am, LPA Saucedo asked for the census, staff, and client rosters. On 12/03/25, at 9:55am, LPA Saucedo conducted a physical tour, interviewed staff and attempted to interview residents.

LIC 9099C-continued
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 31-AS-20251201104955
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: JRBELLA HOME FOR THE ELDERLY
FACILITY NUMBER: 197610195
VISIT DATE: 12/03/2025
NARRATIVE
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Regarding the allegation: Staff unlawfully evicted a resident. It is being alleged that on November 21, 2025, Resident #1 (R1) was medically stable for discharge but the facility did not want them back. LPA reviewed the facilities admission agreement regarding R1, R1’s pre-placement appraisal information, appraisal/needs and services plan, and physician's report. There was no updates to any of the documents since Admission of 2024. There were no resident appraisal and/or updated reappraisals conducted for R1 showing the process of higher level of care for R1 which staff #1 (S1) based their denial of accepting R1 back into the facility. There was no eviction notice given to the resident, resident’s family and Community Care Licensing Department about not accepting/readmitting R1 back to the facility from the hospital. The pre-placement appraisal, physician's report and appraisal/needs and services plan remained the same since R1's admission to the facility confirming that R1 needed total care at the time of admission. Therefore, based on the LPA's record reviews and staff interviews conducted, the allegation is SUBSTANTIATED at this time.

An exit interview was conducted, citation(s) were issued, appeal rights were provided, and a copy of this report was given to the administrator.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 31-AS-20251201104955
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: JRBELLA HOME FOR THE ELDERLY
FACILITY NUMBER: 197610195
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/03/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/17/2025
Section Cited
CCR
87224(a)
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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). Thirty (30) days written notice to the resident is required...This requirement is not met by:
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Licensee/Administrator will ensure to send community care licensing department a proper thirty (30) day notice regarding R1

The POC due date: 12/17/25
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Based on the LPA's Interviews the licensee/administrator failed to ensure that resident #1 (R1) was not given the proper 30 (thirty) day notice for eviction. R1 was not allowed back to the facility after hospitalization discharge. This posed a potential health and safety risk to residents in care.
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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: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 31-AS-20251201104955
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: JRBELLA HOME FOR THE ELDERLY
FACILITY NUMBER: 197610195
VISIT DATE: 12/03/2025
NARRATIVE
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Regarding the allegation: Staff is overcharging a resident. It is being alleged that resident #1 (R1)’s family member paid $4200.00 for the month of November and R1 was not at the facility. R1 was at a Community Living Center for 31 days prior and 14 days at a medical center. During LPA’s interview with a witness, the witness did confirm that R1 still had to pay for rent at the above facility although they were not there for over thirty (30) days. During LPA’s interview with the staff #1 (S1), S1 did confirm that R1 had to pay $4200.00 for their rent because R1’s family did confirm that R1 would be returning and R1’s belongings were still being held at the facility in their room. Upon reviewing R1’s admission agreement, LPA reviewed that the facility will not make a refund of the preadmission fee for residents living in the facility for four (4) or more months. R1 lived in the facility for more than a year. The refund policy also states, "...facility will not refund the resident and/or resident's representative in the event of death, transfer or relocation or any other circumstance upon the departure of the resident." Therefore, based on the LPA's record reviews and staff interviews conducted, the allegation is UNSUBSTANTIATED at this time.


An exit interview was conducted, no citation(s) were issued, and a copy of this report was given to the administrator.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5