306005792-4-9-2026-22-AS-APAO-DTU5NL-20260506200632

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005792
Report Date: 04/09/2026
Date Signed: 04/09/2026 11:13:05 AM

Substantiated

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
10/15/2025 and conducted by Evaluator Samer Haddadin

COMPLAINT CONTROL NUMBER: 22-AS-20251015143305

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: 22	DATE:	04/09/2026
		UNANNOUNCED	TIME BEGAN:	02:05 PM
MET WITH:	Administrator Assistant Sonya Tatunts		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Facility does not have sufficient resources to operate.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced visit to the facility to deliver findings regarding the above-mentioned allegation. Upon arrival, LPA Haddadin was greeted and granted entry by Administrator Assistant Sonya Tatunts
It was alleged that “Facility does not have sufficient resources to operate.” The investigation determined as follows:
The Department conducted a solvency audit after receiving an allegation that the licensee was behind on utility payments and at risk of service interruption. The audit reviewed the facility's October 2025 Profit and Loss report, balance sheet, bank statements, utility bills, lease documentation, and insurance records.
Per a review of the October 2025 Profit and Loss report provided by the Licensee, the facility had a net loss of ($26,373.91). The licensee reported $125,013.37 in revenue across four categories, but the Department was only able to verify revenue earned from one of the revenues. {***Continue9099C***}

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026

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-20251015143305

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/09/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 04/13/2026 Section Cited CCR 87213	1 2 3 4 5 6 7	87213 The licensee shall have a financial plan that conforms to the requirements of Section 87155 that assures sufficient resources to meet operating costs for care of residents; may be required upon the written request of the licensing agency.	1 2 3 4 5 6 7	Licensee will have a financial plan drawn by E mailed to LPA by POC due date
	8 9 10 11 12 13 14	The balance sheet and Profit and Loss Report revealed that the facility lacks sufficient operating funds and cash reserves, has paid utility bills late, and is operating at a net loss, which poses an immediate risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20251015143305

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: 04/09/2026

NARRATIVE

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When asked to support the remaining reported revenue, the licensee did not provide sufficient deposit clarification, and transfers between accounts indicated resident income was not consistently deposited into the facility business checking account.
Balance sheet reviewed showed the facility had a negative working capital of $422,273.45. Bank records further showed the licensee did not maintain cash reserves comparable to one month of operating expenses, and a negative ending balance was noted in March 2025. Utility review showed late charges and disconnection notices during three of the six months reviewed, with no payments made for May, July, September, and October 2025, although Southern California Gas and Spectrum bills were paid timely for the months reviewed.
Therefore, based on records reviewed, the preponderance of evidence standard has been met. The allegation that the “facility does not have sufficient resources to meet operating costs for care of residents” is deemed to be SUBSTANTIATED. The facility is being per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Administrator Assistant Sonya Tatunts, and a copy of this report, LIC 9099-D, and appeal rights were provided at the time of exit.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026

LIC9099 (FAS) - (06/04)

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