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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609098
Report Date: 11/22/2022
Date Signed: 11/22/2022 03:11:53 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/21/2022 and conducted by Evaluator Alberto Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20221121152003
FACILITY NAME:SKYHILL QUALITY LIVING #2FACILITY NUMBER:
197609098
ADMINISTRATOR:ARUTYUNYAN, TINAFACILITY TYPE:
740
ADDRESS:626 N LAMER STTELEPHONE:
(818) 558-5971
CITY:BURBANKSTATE: CAZIP CODE:
91506
CAPACITY:6CENSUS: 6DATE:
11/22/2022
UNANNOUNCEDTIME BEGAN:
10:58 AM
MET WITH:Tina Arutuyan, Administrator TIME COMPLETED:
03:22 PM
ALLEGATION(S):
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Facility staff did not meet resident's bathing needs.
Facility staff did not ensure resident had clean bed sheets.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alberto Lopez visited this facility as an unannounced 10- Day Complaint Visit to investigate the allegations noted above. LPA Met with DSP Elmer Manalang and Administrator Tina Arutyunyan arrived a short time later.

The investigations consisted of obtaining personnel and staff rosters and interviewing Administrator, staff 1 -2 (#1,#2) W#1-W#4, W (W1-W4) and residents 1-6 (R!-R6)
Regarding Allegation: Facility staff did not meet resident's bathing needs. It is alleged that resident has not been bathed in 2 weeks.
Administrator stated that resident is given bed bath 2 times per week and that R1 chooses to have Home Health employee bathe him. 6/6 residents could not collaborate the allegations. S1 stated S1 provides bed bath for R1 every day and R1 confirmed this.
(Continued on 9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2022
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 2
Control Number 28-AS-20221121152003
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: SKYHILL QUALITY LIVING #2
FACILITY NUMBER: 197609098
VISIT DATE: 11/22/2022
NARRATIVE
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 (CONTINUED FROM 9099)

Administrator stated that R1 is too heavy to take to the shower and his bathing consist of bed baths and that R1 choose to have Home Health employee wash R1 hair and assist R1 with bathing. R1 pays W2 cash for her services. W2 stated that she comes 2 times per week and that R1 asked W2 to provide him with service. W2 stated she washes R1 hair and body from waist up only. W2 stated that R1 prefers S1 to wash from waist down and stated that S1 provides that service when she is there. LPA did not smell any body odors while in facility and R1 was clean. 3 of 4 witness could not collaborate the allegations.


Regarding Allegation: Facility staff did not ensure resident had clean bed sheets. Administrator stated that sheets are changed 3 times per week or more if needed. 6/6 residents had clean sheets at the time of visit and 2/2 staff stated that sheets are changed if needed more that the regular changes of 3 times per week. LPA toured all 4 rooms and all had clean sheets at the time of visit. 3 of 4 witness could not collaborate the allegations.

Based on statements and interviews conducted with staff, clients, witnesses. review of client files and observations there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2