197603560-8-10-2022-29-AS-JAPL-CM74Z4-20221216183205

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603560
Report Date: 08/10/2022
Date Signed: 08/10/2022 04:01:03 PM

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 Salia Walker

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: 73	DATE:	08/10/2022
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Evelina Papazyan, Administrator		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility staff failed to respond to resident’s emergency/alert alarm.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Salia Walker arrived unannounced for a subsequent complaint inspection for the above allegation. The LPA met with Administrator Evelina Papazyan at 9:22 a.m., and explained the reason for the visit.

On 07/26/2022, LPA Walker conducted an initial complaint inspection. During the visit, the LPA conducted a physical plant tour with Administrator Evelina Papazyan at 11:25 a.m. From 9:48 a.m. until 10:35 a.m., the LPA conducted an interview with the administrator. From 10:47 a.m. until 11:20 a.m., the LPA conducted interviews with facility resident(s). From 11:36 a.m. until 11:50 a.m., the LPA reviewed and obtained copies of documents pertinent to the investigation.

On 07/27/2022, LPA Walker conducted telephone interview(s) with resident family member(s).
Continue on LIC9099C..

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Salia Walker	TELEPHONE: 818-326-5838
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2022

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: 08/10/2022

NARRATIVE

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During today’s 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.

Regarding the allegation, ‘Facility staff failed to respond to resident’s emergency/alert alarm,’ the complainant’s concern is that on 07/17/2022 (Time Unknown) Resident #1 (R1) allegedly pulled the emergency response cord located in their private restroom to alert staff that they were having a heart attack; and staff did not come to help R1. The complainant is also concerned that the reason for staff not responding to R1’s emergency call was due to no staff being present at the front desk at the time of the call.

During the investigation, LPA Walker conducted interviews with the Administrator, R1, R1’s family member(s), and facility staff. Interview with the Administrator revealed that Staff #1 (S1) was present at the front desk on 07/17/22 at the time that R1 pulled the emergency response cord. According to the Administrator staff responded immediately as they contacted the Administrator to notify of R1 initially refusing medical attention. Interview with R1 revealed that that staff came to R1’s room at the time of the incident after pulling the emergency cord. However, R1 was not able to gage the time it took from the moment they knew something was wrong to calling out for help. Interview with R1 also revealed that staff took care of them Instantly once they saw R1. Interview with R1’s family member(s) revealed that R1 did not have a heart attack on 07/17/22. Interview with R1’s family member(s) also revealed that R1 advised that R1 initially pulled the “chain,” and from R1’s recollection was nothing happened which is when R1’s roommate went to find staff. However, R1’s family member(s) stated that based on time stamps from voicemails left by the facility staff, “it was a timely response." Interviews with facility staff confirmed that S1 was present at the front desk on 07/17/22 at the time R1 pulled the emergency response cord to gain assistance. Interviews with facility staff also revealed that staff responded timely, and notified the administrator, R1’s family, and contacted the paramedics.

Based on interviews which were conducted, there is insufficient evidence to support the allegation ‘Facility staff failed to respond to resident’s emergency/alert alarm.’ Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation(s) 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 provided.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Salia Walker	TELEPHONE: 818-326-5838
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2022

LIC9099 (FAS) - (06/04)

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