306005792-5-9-2026-22-AS-APAO-DU4NL4-20260515103253

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005792
Report Date: 05/09/2026
Date Signed: 05/09/2026 03:23:30 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
06/24/2024 and conducted by Evaluator Samer Haddadin

COMPLAINT CONTROL NUMBER: 22-AS-20240624112308

FACILITY NAME:	BLUE SKY MANOR INC		FACILITY NUMBER:	306005792
ADMINISTRATOR:	SONA HAKOBYAN		FACILITY TYPE:	740
ADDRESS:	280 N WILSHIRE AVE		TELEPHONE:	(714) 844-2667
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92801
CAPACITY:	50	CENSUS: 42	DATE:	05/09/2026
		UNANNOUNCED	TIME BEGAN:	08:31 AM
MET WITH:	Gabriel Airapetian		TIME COMPLETED:	03:50 PM

ALLEGATION(S):

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1-Staff does not provide a good quality of food to residents in care.
2-Staff do not meet the needs of resident in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced site visit to the facility to investigate and deliver findings regarding the allegations that “Staff does not provide a good quality of food to residents in care” and “Staff do not meet the needs of resident in care.” Upon arrival, Administrator (AD) Gabriel Airapetian greeted LPA, granted entry into the facility, and was informed of the purpose of the visit.
During the course of the investigation, LPA conducted a health and safety walk-through of the facility, observed the physical plant, reviewed relevant facility records, and conducted interviews with four staff members and four residents. LPA also reviewed information related to the facility’s food service practices, staffing support, and the residents’ care needs. {***CONTINUE 9099C1***}

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2026

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-20240624112308

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: 05/09/2026

NARRATIVE

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Regarding the allegation that staff does not provide a good quality of food to residents in care, LPA conducted a review of facility operations, documentation, observations, and interviews. During the investigation, LPA reviewed facility invoices dated February 27, 2026, which confirmed that food services are provided by an outside catering vendor. The vendor prepares meal courses, including breakfast, lunch, and dinner, directly at the facility. The facility also employs full-time kitchen staff who assist the vendor with meal preparation and food service. LPA reviewed Food Handler Certificates for relevant staff, which were observed to be active and valid until April 1, 2029. During the record review, LPA confirmed that the facility maintains an active and structured menu. This information was further supported during the health and safety walk-through, during which LPA observed residents eating breakfast that was consistent with the scheduled menu. The meal observed consisted of yogurt with granola and berries, with additional options of scrambled eggs and ham. LPA also observed that residents were being served in a manner consistent with the facility’s posted menu and food service practices. As part of the investigation, LPA conducted interviews with four staff members and four residents. All four staff members denied the allegation and stated that residents are consistently provided meals of adequate quality and quantity. Staff reported that food service is consistent with the facility’s posted menu and that residents have access to snacks and beverages throughout the day. Staff further stated that residents may request meal alternatives if they do not prefer the scheduled meal option. All four residents interviewed also denied the allegation and reported that the food provided by the facility is adequate. None of the residents interviewed expressed concerns regarding food quality, portion size, meal availability, or the facility’s ability to provide regular meals.
Regarding the allegation that “Staff do not meet the needs of resident in care,” LPA interviewed four staff members and four residents. All four staff members denied the allegation and stated that staff assist residents with care needs, supervision, activities of daily living, medication assistance, meals, and general support based on each resident’s individual needs and care plan. All four residents interviewed also denied the allegation and reported that staff are available to assist them when needed.
{***CONTINUE 9099C2***}

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 22-AS-20240624112308

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: 05/09/2026

NARRATIVE

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Residents interviewed did not report neglect, unmet care needs, or concerns regarding staff failing to provide assistance. During the facility walk-through, LPA observed residents’ rooms to be clean, orderly, and sanitary, with no debris, litter, or odors noted. Resident rooms were equipped with clean bedding, fresh linens, and necessary hygiene supplies. Restrooms were observed to be operational, well-maintained, and stocked with incontinence supplies as needed. LPA also tested the facility’s call button system and confirmed that the equipment was functional and that staff responded to alerts in a timely manner. Based on LPA’s observations, there were no immediate health and safety concerns identified during the visit related to unmet resident care needs.
Based on observations, interviews, and records reviewed, the Department is unable to determine whether the above allegations occurred as reported. Although the allegations may have happened or may be valid, there is not a preponderance of evidence to prove or disprove that the alleged violations occurred. Therefore, the allegations are deemed unsubstantiated.
An exit interview was conducted with Administrator (AD) Gabriel Airapetian. A copy of this report was discussed with and provided to AD Gabriel Airapetian at the conclusion of the visit.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2026

LIC9099 (FAS) - (06/04)

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