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Department of
SOCIAL SERVICES
Community Care Licensing
COMPLAINT INVESTIGATION REPORT
Facility Number:
197603560
Report Date:
09/24/2020
Date Signed:
10/06/2020 07:38:53 AM
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
09/09/2020
and conducted by Evaluator
Aja Richardson
COMPLAINT CONTROL NUMBER:
29-AS-20200909141207
FACILITY NAME:
COURTYARD PLAZA
FACILITY NUMBER:
197603560
ADMINISTRATOR:
EVELINA PAPAZYAN
FACILITY TYPE:
740
ADDRESS:
6951 LENNOX AVENUE
TELEPHONE:
(818) 780-5005
CITY:
VAN NUYS
STATE:
CA
ZIP CODE:
91405
CAPACITY:
195
CENSUS:
67
DATE:
09/24/2020
UNANNOUNCED
TIME BEGAN:
10:30 AM
MET WITH:
Evelina Papazyan, Administrator
TIME COMPLETED:
10:45 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is not adhering to the terms and conditions of the Admission Agreement.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
This is an amended report and has been reissued on 10/6/2020. The 9099C did not attach to the 9099 and report was reissued.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME:
Jeralyn Ann Pfannenstiel
TELEPHONE:
(818) 596-4343
LICENSING EVALUATOR NAME:
Aja Richardson
TELEPHONE:
(747) 230-3909
LICENSING EVALUATOR SIGNATURE:
DATE:
09/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/24/2020
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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