197603560-9-13-2023-29-AS-KHEN-CW3S3U-20230927133144

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603560
Report Date: 09/13/2023
Date Signed: 09/13/2023 04:42:13 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
09/06/2023 and conducted by Evaluator Christine Yee

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20230906165547

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: 94	DATE:	09/13/2023
		UNANNOUNCED	TIME BEGAN:	10:35 AM
MET WITH:	Evelina Papazyan, Administrator		TIME COMPLETED:	04:50 PM

ALLEGATION(S):

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1. Staff did not treat resident with dignity and respect.
2. Facility staff are not ensuring the facility is free of vermin.

INVESTIGATION FINDINGS:

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Licensing program Analyst(LPA) Christine Yee conducted an unannounced complaint visit to investigate the above allegations and initially met with Indra Lopez, Staff. Staff contacted Evelina Papazyan, Administrator and she arrived at 10:55am to conduct the visit.
On today's visit, LPA Yee conducted interviews with Evelina Papazyan, Administrator at 10:55am, Indra Lopez, Staff at 10:49am, Resident #1 at 11:27am, Resident #2 at 12:13pm, Resident #3 at 12:40pm, Resident #4 at 1:09pm and Staff #2 at 1:54pm, Staff #3 at 1:59pm, Staff #4 at 2:02pm and Staff #5 at 2:19pm. Copies of documents from Resident #1's file was obtained.

Per information obtained from interviews conducted about allegation #1, Staff did not treat resident with dignity and respect, Resident #5 had moved to the facility in mid-June 2023 and was confused. Residen# #5 was missing from own bedroom and was found sleeeping on Resident #1's bed by staff. Resident #5 was being escorted back to own room by Staff #4 when Resident #1 saw them coming out of their room.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Christine Yee	TELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023

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-20230906165547

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: COURTYARD PLAZA	FACILITY NUMBER: 197603560
	VISIT DATE: 09/13/2023

NARRATIVE

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Resident #1 started screaming and causing a scene and demanded to know what Resident #5 and Staff #4 were doing in Resident #1's room. Per Staff #4, Resident #1 did not observe Resident #5 sleeping on the bed. Resident #5 was escorted back to own room and the staff were able to calm Resident #1 down. This incident was reported to Georgina Osuna, Medication Technician in mid-June 2023. Georgina was informed that Resident #1 got upset because Resident #5 was seen by Resident #1's room. This incident occurred in mid-June 2023. Per interview with Resident #1 today, Resident #1 returned to own room and found Resident #5 on the bed. Resident #5 was confused and Resident #1 got staff to escort Resident #5 back to own room. This incident happened 2 days before this complaint was reported to Licensing on 9/6/23. Per Resident #1, they spoke with the Administrator in the lobby about the incident with Resident #5 on 9/6/23 and the Administrator asked Resident #1 "you liked him in your room." Per Resident #1, the question made them feel they were dis-respected and treated like a prostitute. Per Resident, the Administrator does not know me and no one has ever touched this body. Resident #1 was so upset and felt that a complaint should be filed. Resident #1 was not able to provide any witnesses present in the lobby to corroborate the remark made by the Administrator. Per Resident #1, the incident was told to Resident #2 - Resident #5. Per interview conducted with the Administrator, she denied knowing anything about the bedroom incident or having any discussions with Resident #1. Per the Administrator, she would never make such a comment. Per interviews conducted with staff and residents, no one could corroborate that Resident #5 was found in Resident #1 room at anytime from 9/4/23-9/6/23 other than the one time in mid-June 2023. All staff and residents interviewed also indicated that it was not in Evelina's nature to make such a dis-respectful comment and that Resident #1 does not like the Administrator and wants her fired. Resident #1 also tells lies. Based on the information obtained today, there is insufficient evidence to support the allegation that staff did not treat the resident with dignity and respect.

In regards to the allegation that Facility staff are not ensuring the facility is free of vermin, Per interview with Resident #1, there is no complaint regarding the facility having flies and fleas. Per Resident #1, there are no fleas or flies in resident's bedroom or in the facility except for the flies or bugs that manage to come in when the residents leave the doors open or come in when the residents open the door. This was never meant to be written as a complaint.
Based on today 's investigation, the above allegations are UNSUBSTANTIATED.
Exit interview was conducted and a copy of the report provided

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Christine Yee	TELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023

LIC9099 (FAS) - (06/04)

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