197603560-5-1-2026-29-AS-KHEN-DVHVEY-20260629162306

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603560
Report Date: 05/01/2026
Date Signed: 05/01/2026 12:17:19 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
04/28/2026 and conducted by Evaluator Christine Yee

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20260428145634

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: 87	DATE:	05/01/2026
		UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Marilou Mendoza, Executive Director		TIME COMPLETED:	12:20 PM

ALLEGATION(S):

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1. Staff are not meeting resident's medical needs.

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 Marcela Pereira, Medication Technician. Marilou Mendoza, Executive Director arrived at 9:46am to conduct the visit. The reason for today's visit was provided.

On today's visit, LPA Yee conducted an interview with Marcela Pereira, Medication Technician at 9:35am, Executive Director at 9:48am and a telephone interview with Witness #1 at 10:45am. A copy of Resident #1's file was obtained during the visit.

Per interviews conducted and information obtained, Resident #1 has severe right knee pain and the family wanted to have the resident's doctor take a look at the knee. A family member contacted the doctor's office

continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2026

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-20260428145634

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: 05/01/2026

NARRATIVE

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and an appointment was scheduled to have the doctor visit Resident #1 at the facility on 4/24/26. The facility staff was not made aware of the scheduled visit by the family or the medical provider's office.
The Executive Director was made aware of the missed appointment by the resident's responsible party on 4/24/26. Per the Executive Director, she called the provider's office for a reason for the missed appointment and was told that due to internal mis-communication the appointment was missed. An appointment was re-scheduled with Resident #1's responsible party for May 1, 2026. The Executive Director was notified by phone of the rescheduled appointment on 4/29/26 by the responsible party.

Per contact with Witness #1, the family is not happy with Resident #1's current medical provider and is in the process of switching to another Doctor. Per Witness #1, the family does not have any issues with the facility staff or the Executive Director. Per Witness #1, contact had been made with the Long Term Care Ombudsman's office and they were referred to Community Care Licensing to file the complaint, Per Witness #1, the complaint is against the medical provider not the facility.

LPA Yee was notified at 10:46am that personnel from the current medical provider's office was on-site during today's visit.

Based on the information received on today's visit, there is no evidence to support the allegation that staff are not meeting resident's medical needs, therefore the allegation is unsubstantiated at this time.

Exit interview was conducted and a copy of this report was provided.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2026

LIC9099 (FAS) - (06/04)

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