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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608910
Report Date: 04/26/2022
Date Signed: 04/26/2022 12:24:27 PM


Document Has Been Signed on 04/26/2022 12:24 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 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
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Tina Arutyunyan - Licensee
Akop Ekymyan - Administrator		TIME COMPLETED:
12:30 PM
NARRATIVE
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An office meeting was held at the Monterey Park Adult and Senior Care Regional Office (MP ASCRO) to deliver the Final Findings of a Trust Audit Report involving the following facilities: Skyhill Quality Living #2 197609098: [complaint investigation - Control#:28-AS-20210824090807], Skyhill Quality Living 197608910, Our Sweet Home Inc 197607711, Our Sweet Home Inc #2 197608083, and Our Sweet Home Inc #3 197608084, Attendees present during the meeting were: Licensee/Administrator Tina Arutyunyan,Administrator Akop Ekymyan CCLD Regional Manager Aracely Ramirez, CCLD Audit Department Manager, Jacqueline Juarez, Licensing Program Manager(s) Lisa Hicks, Naira Margaryan, Stefanie Coronel, and Licensing Program Analyst(s) Noemi Galarza, Mary Flores, Yelena Avetisyan, Tuesday Cabiness, and Rosaura Valenzuela. The purpose of the meeting was explained to Licensee Ms. Arutyunyan.

On 08/24/2021 Community Care Licensing Division (CCLD) received complaints against all above noted facilities operated by the same Licensee. The complainant was alleging financial abuse of the residents' Personal and Incidental (P&I) funds. An initial investigation visit was conducted on 09/01/2021. As a part of the complaint investigation, the complaints were referred to the CCLD Audit Department for a Trust Audit. The audit investigation conducted by Jacqueline Juarez concluded the following:

* The Licensee/Administrator Misappropriated residents Personal and Incidental (P&I) funds. Multiple residents did not have access to, or were not distributed P&I funds.
* The Licensee/Administrator failed to maintain adequate safeguards and records for residents' cash resources. Proper documentation for expenditures was not maintained.

* The Licensee/Administrator Commingled the residents P&I monies with facility funds.

See 809-C for report continuation.
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.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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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On today's date, CCLD Audit Manager Jacqueline Juarez delivered findings on the Trust Audit Report and discussed required plan of corrections (POCs). The Licensee/Administrator was notified that she will need to complete the following:

* Refund all residents' enrolled in the Brilliant Corners program the amounts identified in the Trust Audit report and submit proof of repayment.
* Provide proof of Surety Bond that covers each facility license and not the corporation.
* Submit a written plan on how they will distribute P&I funds to residents and bank statements showing that P&I funds have been deposited in a separate trust account.
*Submit an updated Plan of Operation reflecting the changes in population that will be served.

On 10/8/2022, Licensee/Administrator is to submit to the Audit Section the LIC 405's and corresponding receipts for each facility to ensure proper record-keeping. The deficiencies related to the complaint allegation were also discussed during today's Office meeting, and were disclosed in the final complaint investigation report delivered to the Licensee Ms. Arutyunyan. See complaint control number 28-AS-20210824090807.
During the initial complaint investigation visit dated (9/1/2021) resident's files were reviewed. Based on record review observation, LPA observed the resident files were incomplete and/or missing required forms i.e. personal and incidental (P & I) records, original receipts, hospice care plans, and admission agreements were missing authorized representative parties contact information.
  • Licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff.
  • Update all facility admission agreements to include contact information for all residents’ representative parties.
  • Licensee was informed that Quarterly Case Management visits will be conducted.
  • Technical Support Program brochure was email to licensee during this meeting and a referral will be submitted to Residential Technical Support Program for the facility.

Per Title 22 Regulations, Division 6 Chapter 8, Article 09, a deficiency was cited. See LIC 809D.

An exit interview was conducted and a copy of this report was issued to Licensee Tina Arutyunyan.
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
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/26/2022 12:24 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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

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87506 Personal Records: (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff.

This requireement is not met as evidence by:
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Based on record review observations during the visit dated 9/1/21 in reference to complaint # 28-AS-20210824090807, residents' files were incomplete and/or missing required forms i.e. P & I ledgers, hospice care plans, original receipts of P & I expenditures, and authorized representative contact information. This poses a potential health, safety or personal rights risk to 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
LIC809 (FAS) - (06/04)
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