197603560-11-16-2022-29-AS-JAPL-CM74Z3-20221216183205

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603560
Report Date: 11/15/2022
Date Signed: 11/16/2022 10:09:47 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
07/22/2022 and conducted by Evaluator Sandra Urena

COMPLAINT CONTROL NUMBER: 29-AS-20220722135126

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: 72	DATE:	11/15/2022
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Evelina Papazyan		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Insufficient staffing during evening hours.

Staff are not present in the reception area; as a result, residents are not able to gain re-entrance into the facility during the evening hours.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sandra Urena conducted a subsequent unannounced visit to investigate the above allegations. LPA Urena arrived at the facility at 10:30 a.m., met with Administrator Evelina Papazyan, and explained the reason for the visit.

On 08/10/2022, Licensing Program Analyst (LPA) Salia Walker arrived unannounced for a subsequent complaint inspection for the above allegation(s). The LPA met with Administrator Evelina Papazyan at 9:22 a.m., and explained the reason for the visit. During the visit, the LPA spoke briefly with the Administrator and obtained copies of documents pertinent to the investigation. From 9:45 a.m. until 12:15 p.m., the LPA conducted interviews with facility residents. From 2:36 p.m. until 3:15 p.m., the LPA conducted interviews with facility staff.

Continues on LIC 9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2022

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-20220722135126

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: COURTYARD PLAZA	FACILITY NUMBER: 197603560
	VISIT DATE: 11/15/2022

NARRATIVE

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For the allegation that there is ‘Insufficient staffing during evening hours’, LPA Urena conducted additional record review, and interviewed the Administrator from 11:15 a.m. to 12:02 p.m. The record review revealed that four (4) staff are present during the evening shift which is from 3:30 p.m. to 11:30 p.m. Two staff are assigned to the Assisted Living unit, and two staff are assigned to the Memory Care Unit, seven days a week. The evening staff have assigned duties: Incontinence duties. The evening staff (Assisted Living Unit) alternate their schedules to complete their assigned duties throughout their shift. One staff conducts the assigned duties, while the other staff manages the front desk, and vice versa. Resident interviews revealed that staff check on them at night constantly during the night. Staff checks on them even if they are asleep; they have seen two(2) to three (3) staff working at night. They have noticed that the facility is short staffed at times, but there is always staff to cover for any staff that call out; the administrator will even cover, and they have seen the administrator cover when needed. There have been times when they needed help with changing their diaper here and there, and staff comes right away. Furthermore, the times they have called for assistance during the night the most they have had to wait was 10 minutes or less. Another resident stated that when they felt sick and threw up, they called staff and they came right away. The facility's electronic time keeping system for staff, revealed that four (4) staff members sign in at 3:30 p.m., and signed out at 11:30 p.m. Staff interviews revealed that there are four staff working the evening shift.

Based on the information obtained through record review, and interviews, there is insufficient evidence to support the allegation that there is insufficient staff during the evening hours. Therefore, the allegation is Unsubstantiated at this time.

For the allegation that ‘Staff are not present in the reception area; as a result, residents are not

able to gain re-entrance into the facility during the evening hours’. LPA Urena conducted record review, and administrator interview. The residents’ interviews revealed that when their family comes to take them out, there have been times when they returned in the evening, and staff always come to the front door right away. No issues with gaining entrance back into the facility upon returning in the evening. Residents stated that when they have gone out, and return the front entrance has not been locked; to their knowledge the door is always open. The administrator’s interview revealed that evening shift caregivers alternate their assignments schedule, and one caregiver is always at the reception area, while the other caregiver completes her assignments.

Continues on LIC 9099 C...

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2022

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20220722135126

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: COURTYARD PLAZA	FACILITY NUMBER: 197603560
	VISIT DATE: 11/15/2022

NARRATIVE

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A facility inspection of the front desk doorbell was conducted on July 26, 2022 at 11:44 a.m., by LPA Walker along with Administrator Evelina Papazyan. The Administrator pressed the doorbell button approximately four (4) times, and each time the speaker sounded the bell with a light. The doorbell system was functioning properly. On 11/15/2022, at approximately 1:47 p.m., LPA Urena, and the Administrator conducted an additional inspection of the doorbell system, and found the system to be functioning accordingly. The administrator stated that due to the change of weather, and the new daylight savings time, they now close the front door earlier than they did in the spring, summer and fall. The front door is closed when it gets dark outside, for the safety of residents and staff, and due to the homeless population living around the corner of the facility.

Based on information obtained through interviews, record review and facility inspection, there is insufficient evidence to support the allegation that ‘Staff are not present in the reception area; as a result, residents are not able to gain re-entrance into the facility during the evening hours. Although the allegation may have happened or is valid, there is insufficient evidence to prove the allegation did or did not occur. Therefore, the allegation is Unsubstantiated at this time.

No deficiencies cited. Exit interview conducted, and a copy of the report was issued.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2022

LIC9099 (FAS) - (06/04)

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