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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197603560
Report Date: 11/30/2022
Date Signed: 12/01/2022 08:22:19 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
05/11/2022 and conducted by Evaluator Sandra Urena
COMPLAINT CONTROL NUMBER: 29-AS-20220511110219
FACILITY NAME:COURTYARD PLAZAFACILITY NUMBER:
197603560
ADMINISTRATOR:EVELINA PAPAZYANFACILITY TYPE:
740
ADDRESS:6951 LENNOX AVENUETELEPHONE:
(818) 780-5005
CITY:VAN NUYSSTATE: CAZIP CODE:
91405
CAPACITY:195CENSUS: 72DATE:
11/30/2022
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Evelina PapazyanTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff member yells at residents
Staff failed to treat residents with dignity and respect
Facility is in disrepair
Staff member threatens resident with eviction.

INVESTIGATION FINDINGS:
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On 11/30/2022, Licensing Program Analyst (LPA) Sandra Urena conducted a subsequent unannounced visit to investigate the allegations above. LPA Urena arrived at the facility at 9:30 a.m., met with Administrator Evelina Papazyan, and explained the reason of the visit. The LPA and the Administrator conducted a brief physical plant tour of the facility at 12:45 p.m., and the LPA interviewed residents from 1:00 p.m. to 1:30 p.m.

On 05/17/2022, Licensing Program Analyst (LPA) Salia Walker arrived unannounced for an initial complaint inspection for the above allegations. The LPA met with Administrator Evelina Papazyan at 9:20 a.m., and explained the reason for the visit. During the visit, the LPA conducted a physical plant tour with the administrator at 10:15 a.m., interviewed staff at 9:20 a.m., and 9:30 a.m.; reviewed and obtained copies of documents pertinent to the investigation; and interviewed residents at 11:45 a.m., 2:10 p.m., 2:22 p.m., 2:58 p.m., and 3:13 p.m. Further investigation is required prior to issuing findings.
Continues on LIC 9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2022
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 4
Control Number 29-AS-20220511110219
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: 11/30/2022
NARRATIVE
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On the allegation of ‘Staff member yells at residents’, the Reporting Party’s (RP) concern is that the staff yells at R1, and the other elderly residents. To investigate the allegation LPA Walker conducted residents’ interviews on 05/17/2022, and LPA Urena conducted additional residents’ interviews on 11/30/2022. The residents’ interviews revealed that they have never observed staff yelling or screaming at anyone. R1’s interview revealed that staff are nice to R1, and R1 admitted that staff have not yelled at them. The interview with staff revealed that they don’t recall any incident that may have occurred resulting in raising their voice, and added that they have intervened only when residents are arguing with each other or with staff. They stated that they always treat residents with dignity and respect.

Based on the information obtained through interviews, there is insufficient evidence to support the allegation that ‘Staff member yells at residents’ Therefore, the allegation is Unsubstantiated at this time.

On the allegation of ‘Staff failed to treat residents with dignity and respect’, the RP’s concern is that staff are disrespectful to residents. To investigate the allegation LPA Walker conducted residents’ interviews on 05/17/2022, and LPA Urena conducted additional residents’ interviews on 11/30/2022. The residents’ interviews revealed that they feel respected and cared for here, and they are treated with dignity and respect. Residents’ interviews revealed that they have never witnessed staff treat residents inappropriately. R1’s interview revealed that staff are nice to R1, and R1 admitted to being disrespectful to some staff members due to being upset after a particular incident. The staff’s interview revealed that they always treat residents with dignity and respect, even at times when residents are disrespectful.

Based on the information obtained through interviews, there is insufficient evidence to support the allegation that ‘Staff failed to treat residents with dignity and respect’. Therefore, this allegation is Unsubstantiated at this time.

On the allegation of ‘Facility is in disrepair’, the RP’s concern is that the there is a back door which is broken, it has not been fixed and anyone can come into and leave the facility. On May 17, 2022 at 9:20 a.m., LPA Walker interviewed Administrator Evelina Papazyan about the broken back door.

Continues on LIC 9099 C...

SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 29-AS-20220511110219
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: 11/30/2022
NARRATIVE
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The Administrator stated that the only thing that is currently in disrepair is the parking lot gate, ‘The City’s Waste Management backed up into our gate and broke it. Corporate is handling it. The driver came into the facility and told us he broke the gate, and provided the form on who to contact, and file the claim’. The city took a long time to get it fixed, but it is fixed now. LPA Walker interviewed R1 about the facility being in disrepair, and R1 stated, ‘I have not observed any broken doors'. The LPA asked the Administrator about the back gate. During today’s visit (11/30/2022) at 12:46 p.m., LPA Urena, and the Administrator conducted a tour of the parking lot. The LPA and the administrator walked to the rear of the facility where the parking lot is located. The LPA observed the parking lot gate to be in working condition. Additionally, LPA Urena observed a gate door that leads from the facility to the parking lot to be in working condition. The Administrator stated that the gate door is locked in the evenings, as soon as it gets dark. The facility’s front door is used at all times for residents, and staff to enter and exit the facility during the evening hours.

Based on the observations, and the information obtained, there is insufficient evidence to support the allegation that ‘Facility is in disrepair’. Therefore, this allegation is Unsubstantiated at this time.

On the allegation, ‘Staff member threatens resident with eviction’, it is the concern of the RP that R1 is being threatened by staff by saying that they would “Kick them out of the facility”. LPA Walker interviewed R1 regarding the allegation, and R1 stated, ‘The administrator did not threaten to evict me. They told me that I can go and come to the facility as I please, but they asked me to let them know so, they know where I am’. Residents’ interviews revealed that they have not experienced threats about eviction. LPA Walker interviewed the Administrator about the threats to evict residents. The Administrator stated that they do not threaten residents to be evicted. Evictions take place through eviction notices.

Based on the information obtained, and although the allegation may have happened, there is insufficient evidence to support the allegation that ‘Staff member threatens resident with eviction’. Therefore, this allegation is Unsubstantiated at this time.

No citations were issued. Exit interview was conducted. A copy of the report was issued.

SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4