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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608910
Report Date: 04/26/2022
Date Signed: 04/26/2022 12:22:55 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/24/2021 and conducted by Evaluator Mary G Flores
COMPLAINT CONTROL NUMBER: 28-AS-20210824084953
FACILITY NAME:SKYHILL QUALITY LIVINGFACILITY NUMBER:
197608910
ADMINISTRATOR:ARUTYUNYAN, TINAFACILITY TYPE:
740
ADDRESS:3919 W VICTORY BLVDTELEPHONE:
(818) 558-5971
CITY:BURBANKSTATE: CAZIP CODE:
91505
CAPACITY:6CENSUS: 4DATE:
04/26/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Tina Arutyunyan - Licensee
Akop Ekymyan - Administrator 		TIME COMPLETED:
12:30 PM
ALLEGATION(S):
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9
Financial Abuse
INVESTIGATION FINDINGS:
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An Office Meeting was held in the Monterey Park Adult and Senior Care Regional Office (MPASCRO). The attendees present during the meeting: Regional Manager Araceli Ramirez, Audit Department Manager Jacqueline Juarez, Licensing Program Manager(s) (LPM) Lisa Hicks, Stefanie Coronel, Naira Margaryan (Woodland Hills Regional Office (WH ASCRO)), Licensing Program Analyst(s) (LPA) Mary Flores, Noemi Galarza, LPAs WH ASCRO Rosaura Valenzuela, Yelena Avestisyan, and Tuesday Cabiness.

At the time of this Office Meeting a final finding of the investigation report was delivered to the Licensee Representative Tina Arutyunyan Licensee by LPA Mary Flores.

The investigation consisted of the following: On 9/1/21 LPA Flores and Luis Mora conducted a tour/health and safety check of the facility around 10:15am, LPAs interviewed resident #1(R1),#2(R2),attempted to interview resident#3(R3), and #4(R4), staff #1(S1) #2(S2) and contacted administrator over the phone.
(CONTINUED ON LIC 9099C)
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Stefanie CoronelTELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Mary G FloresTELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2022
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 7
Control Number 28-AS-20210824084953
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: SKYHILL QUALITY LIVING
FACILITY NUMBER: 197608910
VISIT DATE: 04/26/2022
NARRATIVE
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LPAs reviewed R1,R2,R3,R4 personal files and requested copies of admission agreement, physician's report, identification and emergency information, pre-appraisal agreement, needs and service appraisal, and DHS/ Brillance Corner documentation. Administrator will email hospice documents and Personal and Incidental (P&I) funds, and mail proof of association documents for staff #2(S2), surety bond, and cable statements. On 9/13/21 LPA Flores conducted an interview with administrator over the phone. During the course of the investigation LPA Flores submitted a request for audit services on 9/20/21. On 11/3/21 Department's audit service met with Licensee Tina Arutyunyan via Microsoft Teams. On 3/8/22 LPA Flores received complete Trust Audit Report.

The investigation reveled the following: Regarding allegation: Financial Abuse. It is alleged, there is an issue of financial abuse and there are no logs to record all monthly deposits and withdrawals from each client's Personal and Incidental (P&I) funds since placement. On 9/1/21 Interviews with residents revealed 1 out 4 residents has not gone to purchase clothe and does not have need of clothes as resident is mostly in bed, 1 out of 4 residents stated to only use regular Spanish channels and does not have someone come sing to them. 1 out of 4 residents stated to have everything they need, and 1 out of 4 residents was out of the facility at the time of the visit. LPAs did not observed clothes listed on purchased receipts, furniture or make up listed in receipts was not observed. On 3/8/22 Trust Audit Report conducted by Audit Services Department revealed multiple residents did not have access to or were not distributed P&I funds. Regarding finding: Multiple Residents did not have access to or were not distribute P&I funds. Brilliant Corners provides funding for R1,R2,R4's rent and P&I amounts which are paid to the licensee in a lump sum amount. On 8/19/21 during a visit by Department of Health Services (DHS) representative interviews were conducted with residents, regarding items listed on handwritten receipts without resident's initials/signature which were requested on 6/11/21 and residents stated to not have received items listed on receipts and furniture listed on receipts were not observed by DHS representative in resident's rooms. Interviews with agencies, licensee, and residents revealed P&I funds were not distribute to residents in care. Regarding finding: Proper Documentation for expenditures was not maintained. Licensee did not maintained proper record keeping of P&I money entrusted to licensee, receipts were hand written and not signed by residents. Regarding finding: Licensee is commingling facility funds with P&I amounts. Brilliant Corners provides funding for R1,R2,R4's rent and P&I amounts which are paid to the licensee in a lump sum amount. Bank statements reviewed revealed personal account and money from funding agency for Skyhill Quality Living and Skyhill Quality Living 2 were maintain int the same account.
(CONTINUED LIC (9099C)
SUPERVISOR'S NAME: Stefanie CoronelTELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Mary G FloresTELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 28-AS-20210824084953
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: SKYHILL QUALITY LIVING
FACILITY NUMBER: 197608910
VISIT DATE: 04/26/2022
NARRATIVE
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Regarding finding: Only residents identified with P&I from Brilliant Corners were affected. It was determined that residents not associated to Brilliant Corner were either able to handle their own money or had a representative on file. Regardining finding: Licensee does not have policies and procedures or proper bonding. Licensee did not ensure to obtain proper bonding for the license facility to be able to safeguard resident's P&I money, current bond covers the corporation and not the license facility.

During a Microsoft teams meeting on 11/3/21 with the department and licensee, licensee was notified to keep records and distribute P&I amounts to residents. The licensee is to pay the residents all P&I amounts since each residents time of placement up to November 2021, as follow: R1 must be pay the total amount of $2329.00 R2 must be pay the total amount of $1104.00 and R4 must be pay the total amount of $1104.00.

Based on interviews and documents review conducted the preponderance of evidence standard has been met, therefore the above allegation(s) are found SUBSTANTIATED. California Code of Regulations Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D.

Exit interview was conducted with Licensee Tina Arutyunyan and a copy of this report, LIC 9099D, and appeal rights were provided.
SUPERVISOR'S NAME: Stefanie CoronelTELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Mary G FloresTELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 28-AS-20210824084953
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: SKYHILL QUALITY LIVING
FACILITY NUMBER: 197608910
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
05/10/2022
Section Cited
CCR
87217(b)
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87217 Safeguard for Resident Cash, Personal Property, and Values (b) Every facility shall take...measures to safeguard residents' cash resources, ... have been entrusted to the licensee...The licensee shall give the residents receipts for all such articles or cash resources.
This requirement is not met as evidence by:
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The licensee will refund P&I funds for R1 amount $2329, R2 amount $1104, and R3 amount $1104 and proof must be submitted to the deparment by 5/10/22.
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Based on documents reviewed licensee did not ensure to maintain record receipts for items purchase with P&I funds for R1,R2,R4 which poses a potential health, safety, personal rights risk to the persons in care.
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Request Denied
Type B
05/10/2022
Section Cited
CCR
87217(c)(1)
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87217 Safeguards for Resident Cash, Personal Property, and Valuables: (c)... facility shall account for any cash resources entrusted...(1) Cash resources include but are not limited to monetary gifts,...personal and incidental need allowances from funding sources such as SSI/SSP.
This requirement is not met as evidence by:
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Licensee will implement policies and procedures regarding resident's cash resources and valuables. Licensee will provide a copy of the policies and procedures to the department by 5/10/22.
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Based on documents reviewed licensee did not ensure to be accountable for resident's cash resources which poses a potential health, safety, or personal rights risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Stefanie CoronelTELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Mary G FloresTELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 28-AS-20210824084953
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: SKYHILL QUALITY LIVING
FACILITY NUMBER: 197608910
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
05/10/2022
Section Cited
CCR
87217(e)
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87217 Safeguards for Residents, Personal Property,and Valuables: (e)Cash resources... which are handled by the licensee... shall not be commingled... used as the facility funds or petty cash, and shall be separate,...from any liability ... in the use of his own or the facility's funds and valuables...
This requirement is not met as evidence by:
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Licensee will open a separate trust account fo resident P&I funds. A document regarding a new bank account will be submitted to the department by 5/10/22.
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Based on documents reviewed licensee did not ensure to maintain a separate account for residents' cash resources wihch poses a potential risk to the health, safety, or personal rights of the persons in care.
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Request Denied
Type B
05/10/2022
Section Cited
CCR
87216(a)
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87216 Bonding: (a) Each licensee,... entrusted to safeguard...cash resources, shall file or have on file with the licensing agency a copy of a bond issued by a surety company to the State of California as principal.

This requirement is not met as evidence by:
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Licensee will obtain a required surety bond. A proof of adequate bond will be submitted to the department by 5/10/22.
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Based on document review the licensee did not ensure to obtain a proper surety bond prior to handling the resident's cash resources which poses a potential health, safety, or personal rights risk to the persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Stefanie CoronelTELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Mary G FloresTELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 28-AS-20210824084953
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: SKYHILL QUALITY LIVING
FACILITY NUMBER: 197608910
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/10/2022
Section Cited
CCR
87405(d)(2-3)(5)
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Administrator - Qualifications and Duties.The administrator shall... If the licensee is also the administrator, all requirements...apply. (2) Knowledge of and ability to conform to... laws, rules and regulations. (3) Ability to maintain or supervise... financial and other records. (5) Good character and a continuing reputation of personal integrity.
This requirement is not met as evidence by:
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Licensee will attend continued education classes provided for Administrators. Licensee will secure the appoitment to attend classes and provide proof of enrollment by 5/10/22.
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Based on documents review licensee did not ensure to maintain accuracy of financial records which poses a potential health, safety, or personal rights risk to the persons in care.
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Type B
05/10/2022
Section Cited
CCR
87215
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87215 Commingling of Money: Money and valuables of residents entrusted to the licensee of one community care facility licensed under a particular license number shall not be commingled with those of another residential care facility...

This requirement is not met as evidence by:
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Licensee is to maintain a separate checking account for facility funds and a separete account for P&I funds, facility expenses and revenue and submit proof of account designated to facility by 5/10/22.
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Based on documentation reviewed licensee did not maintain a separate checking account for facility from personal account which poses a potential health, safety, or personal rights risk to the persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Stefanie CoronelTELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Mary G FloresTELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2022
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 28-AS-20210824084953
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: SKYHILL QUALITY LIVING
FACILITY NUMBER: 197608910
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/29/2022
Section Cited
CCR
87207
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6
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87207 False Claims: No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility.

This requirement is not met as evidence by:
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Licensee/Administrator will schedule vendorized training related to the cited section as well as
87408:Denial or Revocation of a Certificate
87777: ExclusionsPersonal Rights.
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Based on documents reviewed licensee did not ensure to provide accurate information and records to teh LPAs and other agency representatives which poses a health, safety, or personal rights risk for the persons in care.
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Verification of scheduled training with the trainers credentials will need to e submitted by 4/29/2022 and completed by 5/13/2022.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Stefanie CoronelTELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Mary G FloresTELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2022
LIC9099 (FAS) - (06/04)
Page: 7 of 7