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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609098
Report Date: 03/24/2026
Date Signed: 03/24/2026 03:01:17 PM

Document Has Been Signed on 03/24/2026 03:01 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:SKYHILL QUALITY LIVING #2FACILITY NUMBER:
197609098
ADMINISTRATOR/
DIRECTOR:		ARUTYUNYAN, TINAFACILITY TYPE:
740
ADDRESS:626 N LAMER STTELEPHONE:
(818) 558-5971
CITY:BURBANKSTATE: CAZIP CODE:
91506
CAPACITY: 6CENSUS: 3DATE:
03/24/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Tina Arutyunyan-AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Nadia Shahbazian conducted an unannounced Required - 1 Year annual inspection visit. Upon arrival LPA was greeted by Elmer Manalang and explained the purpose of the visit. Administrator Tina Arutyunyan arrived around 11:05am. Residential Care Facility for Elderly (RCFE) is licensed for six (06) non-ambulatory residents ages 60 and above. Facility has a hospice waiver for four (04) and is approved for two (2) bedridden residents, to occupy bedroom#1. Current census is three (3) residents, two (2) of them are non-ambulatory.

LPA toured the facility with the Administrator at 10:50 am and observed the following:

Required postings were observed by the entry door and office area. The house is one-story, in a residential neighborhood and the physical plant appeared clean, sanitary and with no visible immediate hazards. The front entry is the main emergency door with four (4) additional exits (the kitchen, bedrooms #1, #2, and #3) leading to the backyard. There is one (1) fire extinguisher in the kitchen, purchased on 09/24/2025. Facility conducts quarterly fire and safety drills; the last fire/earthquake drill was conducted on 02/05/2026. The dual smoke alarms and carbon monoxide detectors are battery operated. Smoke/carbon monoxide detectors were tested in several rooms and were observed to be functional. Facility is equipped with fire sprinklers in every room and also facility has land-line telephone, cable, internet for resident's use.

Common Areas: Living room is located upon entrance and is furnished with a table and ample sitting for all the residents and staff. There is a television and gaming area in the living room. The office area is located in one corner of the living room. Dining area is located in the kitchen, furnished with a table and six chairs.

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NAME OF LICENSING PROGRAM MANAGER: Mary G Flores
NAME OF LICENSING PROGRAM ANALYST: Nadia Shahbazian
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/24/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: SKYHILL QUALITY LIVING #2
FACILITY NUMBER: 197609098
VISIT DATE: 03/24/2026
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Kitchen: There are two (2) refrigerators, stove and a microwave in the kitchen with a dining table/chairs for six clients. Knives, cutlery and other sharp kitchen utensils are stored and locked in the kitchen drawer. Chemicals, soaps and laundry detergents are kept in a locked cabinet. Food storage and preparation areas are clean and sanitary. LPA found a sufficient amount of perishable food supplies for two (2) days and non-perishable food supplies for seven (7) days in the kitchen.

Bathrooms: There are two (2) full bathrooms for the residents' use. One of the bathrooms is located between room#3 and #4. The other bathroom is shared bathroom between room#1 and #2. All toilets and sinks are maintained in sanitary, operating condition. Functional grab bars and non-slip mats were observed in resident bathrooms. Hot water temperature was tested between 109.9 - 111.7 degrees Fahrenheit.

Bedrooms: There are four (4) bedrooms for resident use. Bedrooms #1 is a shared room, approved for 2 bedridden residents but currently is used as a private room. Bedroom #2 is currently vacant. Bedroom #3 and #4 are shared rooms, but currently are being used as private room. Bedrooms #1, #2 and #3 have exit doors, leading to the backyard. All of the bedrooms were properly furnisshed with appropriate chairs, beddings, chest drawers, linens with sufficient lighting. LPA observed call buttons in each bedroom. While preparing the report at approximately 9:59am, resident in room#4 pushed the call button and staff responded to call button within less than a minute.

Surrounding grounds: Entry/exit gates and pathways were free of obstruction. The outdoor area was free of visible immediate hazards. No bodies of water were observed at the facility. There is a shaded patio area in the front yard, with furniture appropriate for outdoor use, sufficient for number of clients. Facility has a detached garage with a bathroom which currently is used for live-in staff but facility has an awake staff at nights. Laundry machines were located in the backyard but all detergents/chemicals are stored in a locked cabinet in the kitchen.

Medications: The medication are centrally stored and locked in a kitchen cabinet. LPA observed a complete first-aid kit in the office area, with all required supplies and the first aid manual. Medication records for two (2) residents were reviewed and medications were counted for accuracy of administration based on physician orders.



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NAME OF LICENSING PROGRAM MANAGER: Mary G Flores
NAME OF LICENSING PROGRAM ANALYST: Nadia Shahbazian
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2026
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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: SKYHILL QUALITY LIVING #2
FACILITY NUMBER: 197609098
VISIT DATE: 03/24/2026
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Resident/Staff Files: LPA reviewed records for all three (3) residents to ensure compliance of licensing forms. Records for four (4) staff were reviewed to ensure all forms, and trainings and First Aid/CPR certificates are up to date.

Administrative documents: Administrator Certificate Expiration date is 04/05/2027. LPA reviewed and obtained copy of Emergency and Disaster Plan for RCFE LIC610E. Liability insurance was also reviewed with expiration date of 03/06/2027.

Pursuant to Title 22 Division 6 of the CA Code of Regulations no deficiencies were observed during the visit.

Exit Interview Conducted / A Copy of the Report provided to Administrator.

NAME OF LICENSING PROGRAM MANAGER: Mary G Flores
NAME OF LICENSING PROGRAM ANALYST: Nadia Shahbazian
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2026
LIC809 (FAS) - (06/04)
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