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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197603560
Report Date: 04/11/2022
Date Signed: 04/11/2022 04:47:04 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
10/08/2020 and conducted by Evaluator Salia Walker
COMPLAINT CONTROL NUMBER: 29-AS-20201008165626
FACILITY NAME:COURTYARD PLAZAFACILITY NUMBER:
197603560
ADMINISTRATOR:EVELINA PAPAZYANFACILITY TYPE:
740
ADDRESS:6951 LENNOX AVENUETELEPHONE:
(818) 780-5005
CITY:VAN NUYSSTATE: ZIP CODE:
91405
CAPACITY:195CENSUS: 67DATE:
04/11/2022
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Evelina Papazyan, AdministratorTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Facility leaves residents in soiled clothing for extended period of time

Facility staff are not ensuring that residents are eating and drinking

Facility staff are not keeping the facility clean
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Salia Walker arrived unannounced for a subsequent complaint inspection for the above allegations. The LPA met with administrator Evelina Papazyan at 9:30 a.m., and explained the reason for the visit.

On 10/14/2020, LPA Aja Richardson initiated a complaint investigation for the allegations listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, the complaint investigation was conducted telephonically with Administrator Evelina Papazyan. Between 10:30 and 11 am, LPA conducted interviews with Administrator and requested facility documents to be reviewed. The LPA determined further investigation was needed at that time.

Continue on LIC-9099C..
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Salia WalkerTELEPHONE: 818-596-4379
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2022
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 4
Control Number 29-AS-20201008165626
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: COURTYARD PLAZA
FACILITY NUMBER: 197603560
VISIT DATE: 04/11/2022
NARRATIVE
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During today’s visit, the LPA conducted a physical plant tour with Administrator Evelina Papazyan at 10:06 a.m., to ensure there are no health and safety hazards. From 9:30 a.m. until 11:28 a.m., the LPA briefly spoke with the administrator; and reviewed and obtained copies of documents pertinent to the investigation. From 11:28 a.m. until 12:44 p.m.; and between 1:33 p.m. until 1:47 p.m., the LPA conducted interviews with facility residents. From 1:10 p.m. until 1:33 p.m.; and between 2:00 p.m. until 2:30 p.m., the LPA conducted interviews with facility staff.

Regarding the allegation, ‘Facility leaves residents in soiled clothing for extended period of time,’ the complainant’s concern is that residents go 8-10 hours without being changed, due to the facility having insufficient Personal Protection Equipment (PPE) gear such as gloves.

During the investigation, LPA Richardson conducted an interview with the administrator. LPA Walker also conducted interviews with facility residents, and staff. Interview with the administrator revealed that residents were changed 4 or 5 times per shift, in 8 hour shifts. Interviews with facility residents revealed that staff would check on the resident ‘regularly’ wearing PPE gear ‘like mask, shields, and gloves.’ Interviews with residents also revealed that staff would change, and dispose of their gloves in between duties to avoid cross contamination. Interviews with facility staff revealed that during the COVID-19 Pandemic in the year of 2020, the facility continued to perform their duties in providing services to the residents such as assistance with the changing of clothes, brushing teeth, and hair to get the residents ready for the day. Interviews with staff also revealed that staff wore ‘full PPE gear,’ including gloves; and that staff would change, and dispose of their gloves every time they entered/left a resident room.

Based on interviews with the administrator, facility residents, and staff, there is insufficient evidence that residents would go 8-10 hours without being changed, due to the facility having insufficient Personal Protection Equipment (PPE) gear such as gloves. Therefore, there is insufficient evidence to support the allegation ‘Facility leaves residents in soiled clothing for extended period of time.’ Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated at this time.

Continue LIC-9099C..
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Salia WalkerTELEPHONE: 818-596-4379
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 29-AS-20201008165626
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: COURTYARD PLAZA
FACILITY NUMBER: 197603560
VISIT DATE: 04/11/2022
NARRATIVE
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Regarding the allegation, ‘Facility staff are not ensuring that residents are eating and drinking,’ the complainant’s concern is that residents are not receiving appropriate care. The complainant is also concerned that food is dropped off to the resident rooms, but staff do not ensure that residents are eating and drinking.

To conduct the investigation, the LPA attempted to contact the complainant to obtain additional information such as specific residents that required assistant with meals. However, after multiple attempts the LPA was unsuccessful.

During the investigation, LPA Richardson conducted an interview with the administrator. LPA Walker also conducted interviews with facility residents, and staff. Interview with the administrator revealed that Staff would go inside resident rooms with the exception of residents who requested their food be dropped off outside their door. Interviews with facility residents revealed that staff would deliver their meals into their rooms, and would check their plates once they were done. Interviews with residents also revealed that some residents did go through occasions when they would not eat all their meal, however, ‘staff would call on the intercom, or cell phone to check in and offer something else.’ Interviews with staff revealed that staff would monitor residents were eating by checking the plates when picking up the trash. Interviews with staff also revealed that residents that required assistance with feeding were assisted by staff in proper PPE gear. According to staff, if a resident did not want to eat, the facility would offer other options, including ‘Ensure’ as additional nutrition. Staff also reported to the front desk/ office any resident that would not eat or ate minimal.

Based on interviews with the administrator, facility residents, and staff, residents were receiving appropriate care, and the facility was ensuring that residents were provided the require nutrition. Therefore, there is insufficient evidence to support the allegation ‘Facility staff are not ensuring that residents are eating and drinking.’ Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated at this time.

Regarding the allegation, ‘Facility staff are not keeping the facility clean,’ the complainant’s concern is that staff are not cleaning or disinfecting contaminated areas.

Continue on LIC-9099C..
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Salia WalkerTELEPHONE: 818-596-4379
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 29-AS-20201008165626
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: COURTYARD PLAZA
FACILITY NUMBER: 197603560
VISIT DATE: 04/11/2022
NARRATIVE
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During the investigation, LPA Richardson conducted an interview with the administrator. LPA Walker conducted a record review, interviews with facility residents, and staff. Interviews revealed that staff cleaned and disinfected high touch surface areas ‘daily,’ ‘every hour to half an hour.’ Record review confirmed, that the facility staff were disinfecting, and cleaning all high touch surface areas on an hourly basis.

Based on record review, interviews with the administrator, facility residents, and staff the facility was following CDC guidelines and cleaning or disinfecting contaminated areas. Therefore, there is insufficient evidence to support the allegation ‘Facility staff are not keeping the facility clean.’ Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated at this time.

No deficiencies cited. Exit interview conducted and a copy of the report was emailed.
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Salia WalkerTELEPHONE: 818-596-4379
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4