306005792-3-28-2026-22-AS-APAO-DTA443-20260418184537

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005792
Report Date: 03/26/2026
Date Signed: 03/28/2026 03:29:09 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
03/06/2026 and conducted by Evaluator Samer Haddadin

COMPLAINT CONTROL NUMBER: 22-AS-20260306125010

FACILITY NAME:	BLUE SKY MANOR INC		FACILITY NUMBER:	306005792
ADMINISTRATOR:	GABRIEL AIRAPETIAN		FACILITY TYPE:	740
ADDRESS:	280 N WILSHIRE AVE		TELEPHONE:	(714) 844-2667
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92801
CAPACITY:	50	CENSUS: 18	DATE:	03/26/2026
		UNANNOUNCED	TIME BEGAN:	08:21 AM
MET WITH:	AD GABRIEL AIRAPETIAN		TIME COMPLETED:	11:33 AM

ALLEGATION(S):

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Staff overcharged for services not received

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced visit to deliver findings regarding the above-mentioned allegation. Upon arrival, LPA Haddadin was greeted and granted entry by Administrator (AD) Gabriel Airapetlan.
It was alleged that “Staff overcharged for services not received.” LPA conducted interviews with three staff members, all of whom stated that Resident 1 (R1) was never admitted to the facility and that R1’s Responsible Party (RP) paid to reserve a room for R1. LPA also interviewed three residents, all of whom denied any knowledge of the allegation.
In addition, LPA conducted a telephone interview with R1’s RP, who stated that $1,856.66 was paid to reserve the room. The RP further stated that the amount was refunded on March 26, 2026, and that no other complaints or concerns arose.
{***CONTINUE9099C***}

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2026

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 22-AS-20260306125010

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: 03/26/2026

NARRATIVE

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A review of email communications between the Administrator and the RP confirmed the agreement regarding the room reservation and the receipt of the refund in the amount of $1,856.66.
Based on the information gathered during the investigation, including interviews conducted and documents reviewed, the Department is unable to determine whether the above allegation occurred as reported. Although the allegation may have happened or may be valid, there is not a preponderance of evidence to prove or disprove that the alleged violation occurred. Therefore, the allegation is deemed unsubstantiated.
An exit interview was conducted, and a copy of this report was discussed with and provided to Administrator (AD) Gabriel Airapetlan.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2026

LIC9099 (FAS) - (06/04)

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