197603560-12-9-2022-29-AS-JAPL-CM6PJN-20221216102150

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603560
Report Date: 12/08/2022
Date Signed: 12/09/2022 09:10:41 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
12/05/2022 and conducted by Evaluator Sandra Urena

COMPLAINT CONTROL NUMBER: 29-AS-20221205162841

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: 74	DATE:	12/08/2022
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Evelina Papzyan		TIME COMPLETED:	01:14 PM

ALLEGATION(S):

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Facility staff is interfering with resident's right to move from the facility.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced complaint visit for the above allegation. LPA Urena arrived at the facility at 11:30 a.m., met with the Administrator Evelina Papazyan, and explained the reason for the visit.

On the allegation of ‘Facility staff is interfering with resident's right to move from the facility’, the Reporting Party's (RP) concern is that the facility staff was interfering with the transfer of the resident to a new facility by way of using intimidating language, and making R1 cry and afraid. To investigate the allegation, LPA Urena conducted a collateral visit to interview R1 on 12/08/2022 from10:28 a.m. to 10:45 a.m. The interview with R1 revealed that R1 did not feel that anyone was interfering with the move from the facility to another location; and neither felt intimidated, nor made to cry.

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: 12/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022

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-20221205162841

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: 12/08/2022

NARRATIVE

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Additionally, R1 stated that the only conversation they had with the facility staff, was about staff wanting to know the reason for R1 leaving the facility. The LPA interviewed the facility staff about their conversation with R1 prior to R1 leaving the facility, and the interview revealed that they did not in any way were inappropriate in the language they used with R1, and only wanted R1 to be informed about her rights.

Based on the information obtained through interviews, there is insufficient evidence to support the allegation that Facility staff is interfering with resident's right to move from the facility. 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: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 12/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022

LIC9099 (FAS) - (06/04)

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