197603560-4-16-2025-29-AS-KHEN-DG8247-20250429170328

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603560
Report Date: 04/16/2025
Date Signed: 04/16/2025 07:16:08 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
02/20/2025 and conducted by Evaluator Christine Yee

COMPLAINT CONTROL NUMBER: 29-AS-20250220104222

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: 77	DATE:	04/16/2025
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Evelina Papazyan, Administrator		TIME COMPLETED:	07:20 PM

ALLEGATION(S):

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Facility staff are not meeting residents toileting needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christine Yee conducted a subsequent unannounced complaint visit to continue the investigation for the above allegation and met with Evelina Papazyan, Administrator. The reason for today's visit was explained.

On 2/21/25, LPA Yee conducted an investigation into two separate complaints on today's visit. interviews with the Administrator at 10:09am, Staff #1 at 11:21am, Staff #2 at 12:47pm, Staff #3 at 1:04pm, Resident #1 at 1:24pm, Resident #2 at 1:48pm, Resident #3 at 2:23pm and Resident #4 at 2:49pm and Resident #5 at 5:05pm. Due to time constraints, the findings for both complaints investigated on today's visit will be rendered on a return visit. Further investigation is needed at this time. Exit interview was conducted and a copy of this report was provided at the conclusion of the visit.

continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 04/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2025

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-20250220104222

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: 04/16/2025

NARRATIVE

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On today's visit, LPA Yee conducted a joint interview with the Administrator at 11:05am and Staff #1 at 11:08am to clarify conflicting information received from previous visit and Staff #6 at 3:12pm.

Per investigation into the allegation that Facility staff are not meeting residents toileting needs, on 2/16/25 Resident #5 called the front desk for assistance getting up from the toilet using their cell phone around 3:55pm. They waited about 30 minutes and staff still did not show up. Resident #5 cleaned themselves and got back in their wheelchair. Per Resident #5, they called the front desk again around 4:30pm for assistance and told Staff #5 that no one showed up. Per telephone interview with Staff #5, they contacted Staff #6 via walkie talkie to let them know that Resident #5 needed assistance on the initial call for assistance. Per Staff #5, the resident did not indicate what kind of assistance was needed. On the second call to Staff #5 for assistance, Resident #5 ended the call by saying "never mind." Per interview with Staff #6, they did respond to Resident #5's request for assistance around 3 something. Video with date and time stamp provided shows Staff #6 entering the room at 16:51pm on 2/16/25. The time on the camera had not been changed from the daylight saving change in the fall of 2024. Per Staff #6, they helped the Resident change into their night gown because the resident indicated that they were not going down for dinner because a family member had brought them salmon for dinner. Per Staff #6, Resident #5 was not left on the toilet, never. Resident does not require assistance with toileting and does not call for assistance with toileting. Resident #5's calls for assistance are mainly to get changed into a night gown and to remove trash from the room. Resident can't stand having trash on the bed. Per Staff #6, it has been a long time since Resident #5 has requested help going to the bathroom. Conflicting information was obtained from the interviews conducted with the resident and staff. Per the investigation conducted, there is insufficient evidence to support the allegation that facility staff are not meeting residents toileting needs. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur, therefore the allegation is deemed 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: 04/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2025

LIC9099 (FAS) - (06/04)

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