197603560-2-22-2021-29-AS-JAPL-BZ73MX-20210316182305

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603560
Report Date: 02/22/2021
Date Signed: 02/22/2021 02:50:41 PM

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
02/16/2021 and conducted by Evaluator Aja Richardson

COMPLAINT CONTROL NUMBER: 29-AS-20210216115209

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: 64	DATE:	02/22/2021
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Evelina Papazyan		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff did not return resident's equipment after leaving the facility.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Aja RIchardson initiated a complaint investigation for the allegations listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted virtually with Administrator Evelina Papazyan..

At 1pm, initiated visit with the Administrator and conducted interviews with the Administrator as well as Resident #1 (R1) over the telephone. LPA also reviewed R1's records including a document that R1 signed on 3/27/2019 that R1 moved out of facility and removed all of their personal belongs. According to interviews there is no documentation that R1 left Spectrum E\equipiment at the facility and Administrator denies that any equipment was left. Based on document signed by R1 stating they have removed all of the items this allegation is Unsubstantiated.
Exit Interview Conducted. Report Issued. LPA requested signature from Administrator.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Aja Richardson	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2021

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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