197603560-10-3-2023-29-AS-KHEN-CZZ2B4-20240130161432

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603560
Report Date: 10/03/2023
Date Signed: 10/03/2023 03:33:00 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
09/25/2023 and conducted by Evaluator Christine Yee

COMPLAINT CONTROL NUMBER: 29-AS-20230925123516

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: 91	DATE:	10/03/2023
		UNANNOUNCED	TIME BEGAN:	09:55 AM
MET WITH:	Evelina Papazyan, Administrator		TIME COMPLETED:	03:40 PM

ALLEGATION(S):

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1. Staff will not allow resident to have visits/calls from family members

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) conducted an unannounced complaint visit to investigate the above allegation and met with Evelina Papazyan, Administrator. The reason for today's visit was explained.

On today's visit, LPA Yee interviewed Evelina Papazyan at 10:01am, Staff #1 at 10:56am, Staff #2 at 12:25pm, Resident #1 at 10:28am and a telephone interview with family member at 11:43am. Copies of facility documents were requested at 10:23am.

Per information obtained from interviews, Resident #1 was placed at the facility by the resident's oldest daughter in March 2023. In early August 2023, the other two daughters of Resident #1and their children flew in from Hawaii and visited with Resident #1 and had an ejnjoyable time. When the oldest daughter found out about the visit, she hand delivered a self drafted letter, dated August 13, 2023, to 3 staff

continued on LIC9099-C

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: 10/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023

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-20230925123516

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: 10/03/2023

NARRATIVE

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stating that effective immediately Resident #1 was not allowed to have any visitors except the persons that were named in the letter. The persons named in the letter are, the names of the resident's oldest daughter, a granddaughter, 2 grandsons and a family friend. The letter also had the following restrictions:

that Resident #1's mail was to be held in a secure place until it was picked up by Resident #1's oldest daughter.
the facility was also told not to accept or transfer any calls received from anyone except the persons named on the list and the she is to be notified immediately
Also if anyone visits or calls and states that "they were given permission by..." it should not be accepted with any exception and she is to be notified immediately

Included with the letter was a copy of the Power of Attorney. Per interview with the Administrator, the oldest daughter was told that the letter she drafted with the restrictions and the Power of Attorney documents were not enforceable and were filed. Staff were instructed that if any of Resident #1's family questioned them, they were told to refer them to the Administrator. On 9/26/23, office staff received call from one of the daughter's of Resident #1 and she was very upset and was yelling at staff because she was told she and the rest of the family could not visit or call Resident #1. Per the Administrator, she nor any of the staff ever told the daughter or any of the family that they could not visit or call mom. This was confirmed by Staff #1 and Staff #2. The children of Resident #1 are currently on bad terms and are involving the facility in their family disputes which the facility is choosing to stay out off and ensuring Resident #1's personal rights are protected.

Per telephone interview with the family member at 11:43am, the family member was specifically asked if the Administrator or any staff told them that they could not call or visit Resident #1 and the response was a firm no. The staff were very nice. The sister is the one telling them that they cannot visit or call Resident #1 by providing the documents to the facility to enforce. Per the family member they were not yelling at the staff, They were upset and talked loud.

Per information received on today's visit, there is insufficient evidence to support the above allegation. Therefore, the findings of the above allegation is UNSUBSTANTIATED.

Exit interview was conducted and a copy of the report was given.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Christine Yee	TELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023

LIC9099 (FAS) - (06/04)

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