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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607711
Report Date: 04/26/2022
Date Signed: 04/26/2022 12:56:25 PM

Document Has Been Signed on 04/26/2022 12:56 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, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:OUR SWEET HOME INCFACILITY NUMBER:
197607711
ADMINISTRATOR:ARUTYUNYAN, TINAFACILITY TYPE:
740
ADDRESS:16518 DEVONSHIRE STTELEPHONE:
(818) 970-9586
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 6CENSUS: 4DATE:
04/26/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Tina Arutyunyan and Akop EkimyanTIME COMPLETED:
01:00 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 #:31-AS-20210824091525], 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 and Administrator/Assistant Administrator Akop Ekimyan. 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 and Mr. Ekimyan .

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.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Yelena Avetisyan
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, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: OUR SWEET HOME INC
FACILITY NUMBER: 197607711
VISIT DATE: 04/26/2022
NARRATIVE
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  • 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.

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 10/5/2022, 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
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Yelena Avetisyan
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: OUR SWEET HOME INC
FACILITY NUMBER: 197607711
VISIT DATE: 04/26/2022
NARRATIVE
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plans, and admission agreements were missing authorized representative parties contact information. In addition, copies of the LIC 500 Personnel Report, resident roster were not obtained or available at the facility.
  • 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.

A discussion was held with Ms. Arutyunyan regarding observations made during the initial 10 day complaint visit at this facility. Ms. Arutyunyan was informed that a follow up visit will be conducted at a later date to address the deficiencies. A discussion was also held regarding the staff room that was not previously identified in the facility sketch. Per Ms. Arutyunyan and Mr. Ekimyan the staff room is permitted. LPA requested and Ms. Arutyunyan agreed to submit copies of the permits to LPA on or before 5/10/2022.

The Licensee was offered and agreed to receive assistance from the Departments Technical Support Program. A brochure was provided to Ms. Arutyunyan and Mr. Ekimyan during the office meeting.

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 and appeal rights was issued to Licensee Tina Arutyunyan.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Yelena Avetisyan
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 12:56 PM - It Cannot Be Edited


Created By: Yelena Avetisyan On 04/26/2022 at 11:56 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: OUR SWEET HOME INC
FACILITY NUMBER: 197607711

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
04/29/2022
Section Cited
CCR
87506(a)

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Resident Records. 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 requirement was not met evidenced by:
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Licensee/Administrator will review Title 22 regulations section 87506(b)(1-17) as a guide to ensure compliance with the regulation.

Licensee/administrator will review update/complete all residents records including hospice records for the hospice residents.
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Based on record review observations during the visit dated 9/1/21) in reference to complaint # 31-AS-20210824091525, residents' files were incomplete and/or missing required forms. This poses a potential health, safety or personal rights risk to persons in care.
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Once the files have been updated/completed licensee administrator will submit a written notidication to the department confirming that the resident files are all updated and completed

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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:Eva Miller
LICENSING EVALUATOR NAME:Yelena Avetisyan
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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