197603560-3-28-2023-29-AS-JAPL-CSC38Q-20230530180155

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603560
Report Date: 03/28/2023
Date Signed: 03/28/2023 02:34:11 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
03/23/2023 and conducted by Evaluator Christine Yee

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20230323165111

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: 84	DATE:	03/28/2023
		UNANNOUNCED	TIME BEGAN:	09:09 AM
MET WITH:	Evelina Papazyan, Administrator		TIME COMPLETED:	02:40 PM

ALLEGATION(S):

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Facility has pests.

INVESTIGATION FINDINGS:

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Licensing Program Analyst(LPA) Christine Yee conducted an unannounced complaint visit to investigate the above allegation and met with Evelina Papazyan, Administrator. LPA Yee explained the reason for today's visit.

During today's visit, LPA interviewed the Adminstrator at 9:47am, Residents #1 through Resident #4 beginning at 10:16am - 11:12am, Resident #5 at 11:39am, Staff #1 at 11:52am, Staff #2 at 11:59am, Staff #3 at 12:04pm, reviewed and obtained copies of monthly inspection reports at 10:10am, toured bedroom #204 at 11:25am.

Per information obtained from the interviews conducted with the Administrator, Staff

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: 03/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023

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-20230323165111

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: 03/28/2023

NARRATIVE

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#1 through Staff #3, Resident #2- through Resident #4, all stated that they have not observed any fleas or any kind of pests at the facility. Per the Administrator, no one has complained of any insect bites until the time of this visit. Resident #1 just informed the Medication Tech this morning about the flea bites. During the interview and during the tour, Resident #1 indicated that the fleas are all over the bed and are invisible. Per Resident #1, the fleas were brought into the room via the bed linens. The facility has feral cats out in the back courtyard and one got into the laundry room through an open door. Per the Administrator, the laundry room is always locked. Resident #2, roommate of Resident #1, states that 2-3 fleas were observed on the bed a few nights ago and has not been seen since. Per Resident #2, the fleas are tiny and black. Resident #2, did not sustain any flea bites. Per tour of bedroom #204 and inspection of the beds, LPA Yee did not observe any fleas or any signs of a flea infestation on the white bed sheet.

Resident #1 indicated that the flea bites were on the side of the right arm and behind the back of the left shoulder. Per inspection of Resident #1's right arm, the back of the neck an left shoulder, where the alleged flea bites were, the right arm was observed to be slightly swollen with scratch marks and did not look like flea bites and the back neck and left shoulder had no red marks or any signs of flea bites. As a precaution, the facility has notified the primary care doctor and will schedule a visit with the doctor to look at the resident's back, neck and arm.

The facility has a contract with a pest control company that performs monthly preventative services. The common areas are treated monthly. The pest control company will make additional visits to treat the facility if there are any issues that come up, such as bed bugs, fleas, flies and ants. Per review of the services performed in the last 6 months, there have been no pest issues since September 2022.

During today's investigation, LPA Yee was not able to conclusively determine if there are any fleas in the facility, therefore the allegation is UNSUBSTANTIATED at this time.

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: 03/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023

LIC9099 (FAS) - (06/04)

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