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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197603560
Report Date: 05/21/2024
Date Signed: 05/21/2024 05:58:51 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
05/14/2024 and conducted by Evaluator Christine Yee
COMPLAINT CONTROL NUMBER: 29-AS-20240514085611
FACILITY NAME:COURTYARD PLAZAFACILITY NUMBER:
197603560
ADMINISTRATOR:EVELINA PAPAZYANFACILITY TYPE:
740
ADDRESS:6951 LENNOX AVENUETELEPHONE:
(818) 780-5005
CITY:VAN NUYSSTATE: CAZIP CODE:
91405
CAPACITY:195CENSUS: 88DATE:
05/21/2024
UNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Evelina Papazyan, AdministratorTIME COMPLETED:
06:05 PM
ALLEGATION(S):
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Facility staff do not provide a safe environment for resident in care
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 and the reason for today's visit was explained

On today's visit, LPA Yee interviewed the Administrator at 10:49am, Resident #1 at 1:04pm, Resident #2 at 12:04pm, Resident #3 at 11:46am, Resident #4 at 12:42pm, Resident #5 at 2:02pm , Resident #6 at 2:40pm and Staff #1 at 3:04pm.. Resident #1 and Resident #2's files were reviewed at 11:25am and copies of the files were requested at 11:40am.

Per information received from the interviews conducted during today's visit, Resident #1(R1)and Resident #2(R2) have been dating for a couple of years. R2 broke up with R1 on 1/10/24 and the breakup was not received well by R1. R1 would attempt to barge into R2's room or enter through the sliding glass door
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Christine YeeTELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024
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-20240514085611
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: 05/21/2024
NARRATIVE
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located on the patio and sleep in R2's bed. R1 was very possessive of R2. R1 would be verbally abusive with R2 and would send vulgar and threatening text messages and made multiple calls to R2's cell phone and R2 would turn off the phone. Around this time, R1 also threw hot coffee on R2's face because they were angry that R2 was ignoring them. R2's family were notified and the police were called. The police spoke with R1 and staff and did not do anything as no crime was committed. The Administrator spoke with R1 about this incident and outpatient mental health services were arranged. R1 attended the mental health services for a couple of months and then R1 decided to quit. Administrator was told that R1 was not going to attend anymore and preferred to see their own doctor. R1 also saw the facility doctor a few times and quit. In early April 2024, R1 and R2 got back together for a few weeks and R2 broke up again with R1 on 5/1/24. The reason for both the breakups were due to R2's health and not being able perform and fulfill the duties of the relationship. R2, who is 83 years old, is fourteen years older than R1. R1 wanted to desperately marry R2 and at one point in their relationship when R2 was hospitalized and sedated, R1 brought a rabbi to the hospital to marry them. Per information provided, R2 is still legally married.

About a week prior to the second break up, R2 spoke with the Administrator and asked her to speak with R1. R2 did not want to be in a relationship with R1 and wanted to be left alone. Before the Administrator could speak with R1, R2 broke up with R1 on 5/1/24. On 5/3/24, without the Administrator's knowledge, R1 went to court to file a restraining order on R2 alleging that R2 had squeezed R1's head and neck and now is afraid. The restraining order was denied. The police was also called by R1. Per information provided, when the police asked about the head squeezing incident R1 was inconsistent. R1 could not remember when it happened, where it happened or provide the details of the incident. Nothing was done by the police. R1 was simply told to stay away from R2. Per LPA Yee's interview with R1, the resident could not tell LPA Yee where the head and neck squeezing incident occurred. Per R1, the incident happened about a week ago but does not remember the day it happened, where it happened and time of day it happened or what lead up to the incident. Upon further questioning R1 stated that maybe it happened upstairs while they were sleeping in their room at night. R1 does not know how R2 got in the room and does not remember if their room was locked. R1 was getting upset with LPA Yee, saying that LPA does not believe them. Per R1, they have a court hearing on 5/28/24 and stated that they have no evidence or witness to the alleged incident and is relying on the court to take their word because they are honest. Per interview with R2, they never squeezed R1's neck or head. Per interviews conducted, R1 is the aggressor. R1 has been asking residents
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Christine YeeTELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20240514085611
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: 05/21/2024
NARRATIVE
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to go to court on 5/28/24 to testify against R2 but everyone has indicated that they did not see anything. Resident #4 who refused to get involved received nasty text message from R1. Per Staff interviewed, they have always stepped in when R1 has been nasty to R2 and addressing other residents concerns when R1 gets angry at them for refusing to go to court with them. R1 has accused them of not enforcing the restraining order that was denied. R1 states that the Administrator called them a vulgar name and staff hates them.

Based on interviews and record review, there is insufficient evidence to support the claim that staff failed to provide a safe environment to the resident in care, therefore the allegation is deemed unsubstantiated at this time.

No deficiencies were cited on today's visit.

Exit interview was conducted and a copy of this report was provided.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Christine YeeTELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3