Community Care Licensing

Document Has Been Signed on 12/13/2023 04:39 PM - It Cannot Be Edited

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
TYPE OF VISIT:	Case Management - Annual Continuation	UNANNOUNCED	TIME BEGAN:	02:13 PM
MET WITH:	Evelina Papzyan, Administrator		TIME COMPLETED:	04:45 PM

SUPERVISORS NAME: Kristin Heffernan LICENSING EVALUATOR NAME: Christine Yee 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

Link to Parent Document Below:

FACILITY NAME: COURTYARD PLAZA	FACILITY NUMBER: 197603560
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/13/2023

Type B

Section Cited

CCR

87303(a)

87303 Maintenance and Operation: (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above per tour of the resident rooms - bedrooms #111, 126, 220, 221, 226 the horizontal blinds on the window and doors were observed missing slates or were broken which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/27/2023
	Plan of Correction
1 2 3 4	Licensee will conduct an inspection of the windows and doors in all resident bedrooms and replace all missing slates on the windows and doors by POC date - 12-27-23

Type B

Section Cited

CCR

87303(a)

87303 Maintenance and Operation: (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above per tour of the facility, the flooring of the balcony located by the second floor library was observed to be warped, bubbling and un-glued, causing an uneven walking surface which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/27/2023
	Plan of Correction
1 2 3 4	Licensee will conduct an inspection of all common areas accessible for residents use to ensure that the flooring is in good condition or conduct repairs to the floor to ensure that the flooring does not pose a tripping hazard by the POC date - 12/27/23

SUPERVISOR'S NAME: Kristin Heffernan LICENSING EVALUATOR NAME: Christine Yee LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2023

Link to Parent Document Below:

FACILITY NAME: COURTYARD PLAZA	FACILITY NUMBER: 197603560
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/13/2023

Type B

Section Cited

CCR

87307(a)(3)(E)

87307 Personal Accommodations and Services: (a) Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility. The following provisions shall apply: (3) Equipment and supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each resident. The resident may provide the following items; however, if the resident is unable or chooses not to provide them, the licensee shall assure provision of: (E) Portable or permanent closets and drawer space in the bedrooms for clothing and personal belongings. A minimum of eight (8) cubic feet (.743 cubic meters) of drawer space per resident shall be provided. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above per the rooms inspected, bedrooms #231 and bedrooms #236 contained only one dresser each. The other residents were using their desk drawers as dressers whiich poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/27/2023
	Plan of Correction
1 2 3 4	Licensee will ensure that the residents are provided with the minimum required Title 22 furniture including a dresser. Licensee will conduct an inspection of all resident rooms to ensure that the residents who do not bring in their own furniture are provided with a dresser that meets Title 22 requirements by 12/27/27

SUPERVISOR'S NAME: Kristin Heffernan LICENSING EVALUATOR NAME: Christine Yee LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2023

Link to Parent Document Below:

FACILITY NAME: COURTYARD PLAZA	FACILITY NUMBER: 197603560
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/13/2023

Type B

Section Cited

CCR

87303(a)

87303 Maintenance and Operation: (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above per tour of room #120, the front wooden panel of the bedroom door was observed to be warped and separating from the frame which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/27/2023
	Plan of Correction
1 2 3 4	Licensee will conduct an inspection of all bedroom doors to ensure that all the doors are well maintained or conduct repairs to the doors in addtion to the door on bedroom #120 by 12/27/23

Type B

Section Cited

CCR

87303(a)

87303 Maintenance and Operation: (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above per tour conducted of bedroom #201, the stucco and paint on the ceiling of the room were chipping and cracking which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/27/2023
	Plan of Correction
1 2 3 4	Licensee will conduct tours of all the resident rooms to ensure that the ceilings are in good repair or conduct repairs, including repairs to the ceiling in bedroom #201 by 12/27/23.

SUPERVISOR'S NAME: Kristin Heffernan LICENSING EVALUATOR NAME: Christine Yee LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2023

Link to Parent Document Below:

FACILITY NAME: COURTYARD PLAZA	FACILITY NUMBER: 197603560
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/13/2023

Type B

Section Cited

CCR

87303(f)(3)

87303 Maintenance and Operation: (f) Solid waste shall be stored and disposed of as follows: (3) All containers, except movable bins, used for storage of solid wastes shall have tight-fitting covers on the containers; shall be in good repair; shall have external handles; and shall be leakproof and rodent-proof. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above per tour of the back parking lot, all the facility dumpsters stored in the back parking lot containing discarded items, including food items were left wide open which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/27/2023
	Plan of Correction
1 2 3 4	Licensee will ensure that all containers used to store solid waste are kept tightly sealed at all times. Submit POC by 12/27/23. *****************Dumpsters were observed tightly sealed on today's visit**************

Type B

Section Cited

CCR

87303(a)

87303 Maintenance and Operation: (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above per tour of the outside areas, all the outside areas need general cleaning. Discarded items stored along the backside of the kitchen and the large rolls of artificial grass stored in the center of the courtyard needs to be stored away which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/27/2023
	Plan of Correction
1 2 3 4	Licensee will ensure that the outside areas are cleaned and maintained for resident use at all times. Licensee will perform general cleaning and store/discard all items stored in the outside areas to ensure that the residents are safe and healthy by POC dated - 12/27/23.

SUPERVISOR'S NAME: Kristin Heffernan LICENSING EVALUATOR NAME: Christine Yee LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2023