197603560-3-7-2023-29-AS-JAPL-CR2SZK-20230419141913

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603560
Report Date: 03/07/2023
Date Signed: 03/07/2023 04:20:13 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 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
03/03/2023 and conducted by Evaluator Christine Yee

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20230303104051

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: 79	DATE:	03/07/2023
		UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Evelina Papazyan, Administrator		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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1. Resident not accorded dignity in their personal relationships with staff.
2. Facility does not provide adequate food service.
3. Improper rent increase.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christine Yee conducted an unannounced intial complaint visit to investigate the above allegations and initially met with Indra Lopez at the time of arrival. The Administrator was contacted via telephone and arrived at 9:20am to conduct the visit. The reason for today's visit was explained.

On today's visit, LPA Yee conducted interview with the Administrator from 9:22am - 10:13am, Staff #1 from 12:57pm-1:12pm and interviews with Resident #2 through Resident #6 beginning at 10:14m to 12:20pm in the conference room. Lunch was observed at 12:25pm. Resident #1's file was reviewed at 1:30pm. Copies of facility records, including the menu was obtained. Kitchen was toured from 2:14pm - 2:36pm.

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Christine Yee	TELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023

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 3

Control Number 29-AS-20230303104051

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: COURTYARD PLAZA	FACILITY NUMBER: 197603560
	VISIT DATE: 03/07/2023

NARRATIVE

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Per interviews conducted with the Administrator and Staff# 1 regarding allegation #1-Resident not accorded dignity in their personal relationship with staff, they and all the other staff do not disrespect or harass any resident. They do not yell or call residents names. Residents interviewed deny that the staff disrespect them, yell at them or call them names. All the residents interviewed stated that the staff are very nice, lovely, kind and one resident even stated that they are fabulous. Per the residents, the person who is saying those things is a liar. Both staff and residents, have stated that the only person going around yelling, calling everyone names, and intimidating other residents and staff is Resident #1. Resident #1 is racist and does not like anyone that is from a different culture. Resident #1 curses at everyone, calls them names, makes offensive racial slurs while in the dining room or lobby and screams at residents from different cultures to leave their shared dining table. Per the administrator, she had a meeting with Resident #1 to address the resident's behavior in the dining room and how the other residents were feeling about being bullied. The residents ignore or stay away from Resident #1.

In regards to allegation #2 - facility does not provide adequate foot service, residents interviewed indicated that the food at the facility is either okay, alright and one resident said it was perfect. Residents interviewed indicated that everyone complains about the food either because they don't like something due to personal preference or they want a variety of foods. Per review of the facility menu, the facility serves chicken, pork, fish and beef with various kinds of vegetables and rice, quinoa, bulgur and couscous. Residents want the facility to serve other types of fish in addition to tilapia. The facility has a food committee to discuss food issues and consider residents' food preferences that can be incorporated into the facility menu..

Regarding Allegation # 3 - improper rent increase, the facility increased the rent on 1/1/23 as a result of the increase in the annual SSI/SSP rate. All residents receiving SSI and ALW had rent increases except for residents on private pay. A copy of PIN 22-10-CCLD dated 11/15/2022 for the Estimated SSI/SSP Payment Standards effective January 1, 2023 was mailed to responsible parties/families and handed to residents who handle their own

continued on LIC9099-C

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Christine Yee	TELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 29-AS-20230303104051

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: COURTYARD PLAZA	FACILITY NUMBER: 197603560
	VISIT DATE: 03/07/2023

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	finances. Per the administrator, telephone calls were also made to the families and face to face meetings were conducted with the residents regarding the increase. Based on the information received on today's visit, the findings of the investigation is unsubstantiated for the above allegations. Exit interview was conducted and a copy of the report was provided.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Christine Yee	TELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023

LIC9099 (FAS) - (06/04)

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