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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197603560
Report Date: 08/25/2025
Date Signed: 08/25/2025 05:33:53 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
08/19/2025 and conducted by Evaluator Christine Yee
COMPLAINT CONTROL NUMBER: 29-AS-20250819160550
FACILITY NAME:COURTYARD PLAZAFACILITY NUMBER:
197603560
ADMINISTRATOR:EVELINA PAPAZYANFACILITY TYPE:
740
ADDRESS:6951 LENNOX AVENUETELEPHONE:
(818) 780-5005
CITY:VAN NUYSSTATE: CAZIP CODE:
91405
CAPACITY:195CENSUS: 75DATE:
08/25/2025
UNANNOUNCEDTIME BEGAN:
01:08 PM
MET WITH:Evelina Papasyan, AdministratorTIME COMPLETED:
05:40 PM
ALLEGATION(S):
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Staff do not safeguard resident's personal belongings.
INVESTIGATION FINDINGS:
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Licensing Program Analyst(LPA) Christine Yee conducted an unannounced complaint visit to investigate the above allegation and met with Evelina Papazyan, Administrator. Also participating in today's visit was Aaron Feingold, Administrative Assistant. The reason for today's visit was provided.

On today's visit, LPA Yee interviewed the Administrator at 1:18pm, Staff #1 at 3:30pm, Staff #2 at 3:37pm, Resident #1 at 2:43pm and Witness #1 at 1:44pm. The following documents were requested from Resident #1's file - Identification and Emergency Information, Preplacement Appraisal Information, Resident Appraisal, Appraisal/Needs and Services Plan, Physicians Report and Residence and Service Agreement. Also obtained was a copy of the LIC624 for an incident that occurred on 2/25/25. Resident #1 indicated that a frozen chicken leg and a water bottle had been removed from the refrigerator. Staff helped resident look for the missing items and observed that the refrigerator had chicken and water. Resident #1 stated that they

continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2025
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 2
Control Number 29-AS-20250819160550
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: 08/25/2025
NARRATIVE
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were missing a chicken leg and a bottle of water. Per interview conducted with Resident #1, they were asked why they believed that staff took the frozen chicken leg, bottle of water and all their compression socks. Resident #1 stated that they did not say that staff took those items. Per Resident #1, anyone could have taken it. They do not know who took them. They were also missing Social Security and IRS paperwork. Per Resident #1, they reported the theft to the police and the police helped them look for the paperwork and were able to locate the cover sheets for the social security in the night stand drawer. Per Resident #1, the paperwork was kept in their suitcase. Resident #1 refused to allow staff to help them locate the missing items when LPA Yee offered the staff's services. Per Resident #1, the caregivers and housekeepers all have keys to their room. Per Resident #1, no one should be coming into their room. Per resident, they used to leave their sliding glass door to the balcony ajar in the morning. Resident #1 also indicated that their room would be full of smelly gas like smoke in the early morning and does not know where it was coming from. It could be coming from the air vents or from the outside because the sliding glass door was ajar. Resident #1 indicated that they recognize cigarette smoke but couldn't identify the smelly smoky gas in their room.

Per interviews conducted with Staff, they cannot imagine how anyone could take anything from Resident #1's room. The resident is very anxious and never leaves the room and staff do not enter the resident's room when they are not there. Resident #1 does not go down to the dining room and does not participate in any activities. Resident #1 orders food twice a week from InstaCart. Resident #1, does not allow anyone in their room. During the interview conducted with Resident #1 in their room, LPA Yee was shown a gallon sized plastic zip log bag with multiple pairs of socks inside and a sandwich sized zip lock bag supposedly containing drug paraphernalia that was wrapped in a facial tissue. These bags were given to staff at the end of the interview. Resident #1 claimed that the socks were not theirs and the sandwich bag did not contain any drug paraphernalia when the contents were emptied on to a towel. It contained about 5 sandwich bags and the cap of a makeup pencil. Interviews conducted with the Staff #1 and Staff #2, they deny that they took anything from the resident or threw any paperwork out by accident. Per the Administrator, Resident #1 never reported to her that their compression socks and paperwork was missing. She is only aware that Resident #1 was missing a frozen piece of uncooked chicken because the police called her about the missing chicken. At this time there is insufficient evidence to support the allegation that the staff do not safeguard the resident's personal belongings. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated at this time.
Exit interview was conducted.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2025
LIC9099 (FAS) - (06/04)
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