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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197603560
Report Date: 06/11/2024
Date Signed: 06/11/2024 03:17:52 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
06/06/2024 and conducted by Evaluator Christine Yee
PUBLIC
COMPLAINT CONTROL NUMBER: 29-AS-20240606161017
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: 85DATE:
06/11/2024
UNANNOUNCEDTIME BEGAN:
10:14 AM
MET WITH:Evelina Papazyan, AdministratorTIME COMPLETED:
03:25 PM
ALLEGATION(S):
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1. Staff emotionally abused resident
2. Staff violated resident's personal rights
INVESTIGATION FINDINGS:
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Licensing Program Analyst(LPA) Christine Yee conducted an unannounced complaint visit to investigate the above allegations and met with Evelina Papazyan, Administrator. The reason for today's visit was explained.

On today's visit, LPA Yee conducted interviews with the Administrator at 10:22am, Resident #2 at 11:12am, Resident #1 at 11:44am, Staff #1 at 12:31pm and Staff #2 at 1:00pm. Facility documents were collected throughout the visit.

Per interviews conducted, Resident #1 had been hospitalized for a respiratory condition and had returned to the facility on 6/1/24. On 6/2/24, around 7pm, a woman showed up at the facility and identified herself at the front desk as a nurse with the Sherman Oaks Hospital Home Health. She was at the facility to see Resident #1. Staff #1 was confused because Resident #1 was already receiving home health services with
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: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024
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-20240606161017
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: 06/11/2024
NARRATIVE
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another home health agency. Staff #1 advised the woman that they would have to call the Administrator for clarification and the woman told Staff #1 that she could speak with the Administrator, but she was going to see the Resident #1 and walked away. Per the woman, Resident #1 was not happy with her current home health agency and that they did nothing for Resident #1. Per Staff #1, the woman had already called a few minutes earlier while she was looking for parking and spoken with a co-worker and had already obtained Resident #1's room number. Per interview with Resident #1 and Resident #2, roommate, they were confused. The woman said she was from Sherman Oaks Hospital and they did not know why she was there. Resident #1 thought they did something wrong. Per Resident #1, the woman asked about showers and the woman was told that the facility charged $400 a month for showers and the woman advised that the showers would be free with her agency, the woman asked where they obtained their medications, laundry services and many other questions. Per Resident #1, they were already receiving home health services and was very happy with the current home health agency. Per Resident #1, they were lead to believe that the women was collecting information for the hospital since a follow up visit was pending at the hospital. Per Resident #1, they did not request home health services. Per Resident#1, the woman had her sign documents handed to her during the room visit but no explanation was given. Per Staff #1, the Administrator was contacted and the phone was given to the woman during her visit to Resident#1's room. Per the Administrator, she had no idea what this visit was all about since Resident #1 never informed her that she was unhappy with the current home health agency or no new orders were received. She did not prevent the visit as Resident #1 is allowed to chose own home health agency and asked the woman to call her the following day to discuss the matter. On 6/5/24, Resident #1, who was still confused, approached the Administrator and asked her why the woman who spoke with her and had her sign documents since she never requested a new home health agency. The Administrator advised Resident #1 that they could call the agency together to straighten out things. The call was made utilizing the speaker phone from the Administrator's office. The Administrator informed the woman for the reason for the call. Resident #1 indicated that they were happy with the current services and the woman went off on the Administrator and loudly accused her of manipulating Resident #1. The woman indicated that the resident was not happy with the current home health services and that the resident had the right to choose their own home health agency. A gentleman also loudly joined in the telephone conversation. Per the Administrator, she was not allowed to say anything. Per Resident #1, they did not feel emotionally abused, intimidated or felt that their personal rights were being violated by the Administrator. They felt supported by the Administrator who was looking out for them. It was the woman and
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Christine YeeTELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 29-AS-20240606161017
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: 06/11/2024
NARRATIVE
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gentleman who were the aggressors. The Administrator did not yell. This was also confirmed by Staff #2. Per Resident #1, this is the first place that she feels like she belongs.

Based on the interviews conducted, there was insufficient evidence to support the allegations that the staff emotionally abused resident and staff violated the resident's personal rights. Therefore the findings for both the allegations are unsubstantiated.


Exit interview was conducted.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Christine YeeTELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3