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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197603560
Report Date: 02/02/2023
Date Signed: 02/13/2023 08:35:28 AM


Document Has Been Signed on 02/13/2023 08:35 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



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: 71DATE:
02/02/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Indra Lopez, Administrator AsstTIME COMPLETED:
09:00 AM
NARRATIVE
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Licensing Program Analyst(LPA) Christine Yee conducted an unannounced case management visit to correct the citation section cited on the LIC421 IM (7/17) generated on 1/20/2022 for complaint #29-AS-20210419162045.
LPA Yee met with Indra Lopez, Administrator Assistant and the reason for the visit was explained.

On 1/20/22, the substantiated findings of the investigation for complaint # 29-AS-2021041916204 was delivered and citations were issued under California Code of Regulations, Title 22, Division 6 Chapter 8, Section 80078(a) and immediate civil penalties were assessed using form LIC421 IM. Amended LIC9099, LIC9099-C and LIC9099-D reports were later generated to correct the section cited on the LIC9099-D to 87468.2(a)(4). The LIC421 IM was not amended at the time. The purpose of today's visit is to correct the citation referenced on the LIC421 IM to also read 87468.2(a)(4).

Exit interview was conducted with Indra Lopez and a copy of this report was provided with a copy of the corrected LIC421 IM.
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Christine YeeTELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:
DATE: 02/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/02/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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