<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005792
Report Date: 07/11/2025
Date Signed: 07/11/2025 02:09:52 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/20/2024 and conducted by Evaluator Cheyenne Ratajczak
COMPLAINT CONTROL NUMBER: 22-AS-20241220082554
FACILITY NAME:BLUE SKY MANOR INCFACILITY NUMBER:
306005792
ADMINISTRATOR:SONA HAKOBYANFACILITY TYPE:
740
ADDRESS:280 N WILSHIRE AVETELEPHONE:
(714) 844-2667
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY:50CENSUS: 25DATE:
07/11/2025
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Sona HakobyanTIME COMPLETED:
02:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff engaged in inappropriate interactions with resident in care
Staff made inappropriate comments towards residents in care
Staff illegally evicted resident in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived at the facility unannounced and met with Program Director Sona Hakobyan to deliver findings for the above complaint allegations.

During the investigation, the department conducted interviews and reviewed documentation pertinent to the investigation.

The results of the investigation are as follows:

***Report continued on 9099-C***
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cheyenne Ratajczak
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2025
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 3
Control Number 22-AS-20241220082554
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: BLUE SKY MANOR INC
FACILITY NUMBER: 306005792
VISIT DATE: 07/11/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Allegation: Staff engaged in inappropriate interactions with resident in care-Unsubstantiated
LPA conducted interviews with facility staff and resident to investigate this allegation. Staff interviews indicated that they have not witnessed another staff member act inappropriately towards residents. Resident interviews revealed they have not had a staff member be inappropriate towards them. Resident interviews further revealed they have good interactions with facility staff. During visit LPA observed staff to have a positive interaction with residents in care.

Allegation: Staff made inappropriate comments towards residents in care-Unsubstantiated


During the department’s investigation, LPA conducted interviews with staff and residents. Resident interviews revealed that they have never had staff at the facility yell or talk to them in an inappropriate way. Interviews with staff indicated that they have never heard another staff speak inappropriately to residents in care. During visit LPA observed staff to have a positive interaction with residents in care.

Allegation: Staff illegally evicted resident in care- Unsubstantiated


Interview with Program Director revealed that Resident #1 (R1) was not evicted from the facility. R1 had left the facility in December of 2024 as a self exit. R1 had packed up their belongings and left the facility. R1 was part of the facilities recuperative care. LPA was unable to interview R1.

Based on interviews conducted by the Department and records review, the preponderance of evidence standards has not been met. Therefore, the above allegation is found to be UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

At this time no citations were issued.
Exit interview was conducted and a copy of this report was provided to the facility.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cheyenne Ratajczak
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/20/2024 and conducted by Evaluator Cheyenne Ratajczak
COMPLAINT CONTROL NUMBER: 22-AS-20241220082554

FACILITY NAME:BLUE SKY MANOR INCFACILITY NUMBER:
306005792
ADMINISTRATOR:SONA HAKOBYANFACILITY TYPE:
740
ADDRESS:280 N WILSHIRE AVETELEPHONE:
(714) 844-2667
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY:50CENSUS: 25DATE:
07/11/2025
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Sona HakobyanTIME COMPLETED:
02:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff allows resident in care to sell marijuana
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived at the facility unannounced and met with Program DIrector Sona Hakobyan to deliver findings for the above complaint allegations.

During the investigation, the department conducted interviews and reviewed documentation pertinent to the investigation.

The results of the investigation are as follows:The resident in question's room was searched and no marijuana was found and the resident also denied it during an interview. Based on information obtained through interviews, the Department finds the allegations to be UNFOUNDED, meaning that the allegations were false, could not have happened and/or is without a reasonable basis.

Exit interview conducted and a copy of the report was left at the facility.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cheyenne Ratajczak
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3