197603560-12-13-2023-29-AS-KHEN-CZZ2E4-20240130161918

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603560
Report Date: 12/13/2023
Date Signed: 12/13/2023 04:36:53 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
12/12/2023 and conducted by Evaluator Christine Yee

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20231212143123

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: 92	DATE:	12/13/2023
		UNANNOUNCED	TIME BEGAN:	09:51 AM
MET WITH:	Evelina Papazyan, Administrator		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Staff will not allow resident to return back to the facility

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christine Yee conducted an unannounced complaint visit to investigate the above allegation and initially met with Indra Lopez. Evelina Papazyan, Administrator was contacted and she arrived a little later to conduct the visit. The reason for today's visit was provided.

On today's visit, in person interviews were conducted with the Administrator at 10:01am, Indra Lopez, Office Staff, at 10:31am and telephone interviews were conducted with Resident #1(R1) at 10:41am and Witness #1(W1) at 11:08am. Copies of documents for R1 was reviewed and obtained during the visit.

Per information received from the interviews conducted, Resident#1's doctor discharged the resident on 12/12/23 for the medical condition that the resident was hospitalized for on 12/2/23. However, during the hospital stay, Resident #1 was diagnosed with Covid-19 on 12/8/23. Resident #1 had a high fever and was

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: 12/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023

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-20231212143123

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: 12/13/2023

NARRATIVE

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placed in isolation. When the discharge paperwork was written up on 12/12/23, R1 contacted the Administrator to advise her that R1 was going to be discharged that day(12/12/23). Witness #1 also contacted the Administrator about R1's discharge. Per discussion between the Administrator and Witness #1, the resident would be out of the 5 day isolation period on 12/14/23 per physician's note. The Administrator indicated that Resident #1 could return once the isolation period was completed. No one told R1 or W1 that resident could not return to the facility. Also, per facility staff interviews, hospital staff made references to dates of return, the facility did not. The return date of 12/19/23 was never mentioned by facility staff. Witness #1 relayed the date that the isolation would be completed to Resident #1 and per Witness #1, Resident #1 was okay with it. Resident #1 was also being indecisive. Resident#1 would tell the hospital staff that they wanted leave and than change their mind. This went back and forth with the hospital staff. The facility staff was also getting calls from different nurses about the discharge. Per interview with Witness #1, a skill nursing facility that accepts Covid-19 patients was located today and resident could be discharged today to the nursing home if R1 wanted. This option would allow R1 to stay longer if the stay needed to be extended since R1 is indicating continued vomiting and excruciating pain. Per information provided by Witness #1, R1 was advised of the availability at the skilled nursing facility but R1 refused be discharged to the nursing home today(12/13/23). Per Witness #1, the only option available to R1 now is to wait out the isolation period so R1 could return to facility if there are no complications. Per interview with Resident #1, resident was made aware on 12/12/23 that the isolation period was over on 12/14/23 but the hospital case worker indicated that the isolation period was until 12/19/23. Per Witness #1, this was due to mis-communication.

Based on the information received through the interviews conducted on today's visit, the finding for the above allegation is unsubstantiated.

Exit interview was conducted.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Christine Yee	TELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023

LIC9099 (FAS) - (06/04)

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