Skyhill Quality Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Nadia Shahbazian conducted an unannounced annual required visit and inspection of the facility. LPA met with Tina Arutyunyan - Administrator and explained the reason for the visit. The facility is licensed to serve six (6) non-ambulatory residents, of which (1) may be bedridden. Facility has an approved waiver for (4) hospice residents. At 10:45am, with the assistance of Administrator, LPA took a tour of the physical plant. The facility is a one story structure with six (6) bedrooms, two (2) bathrooms, kitchen, dining room, living room and office area. Required postings were observed in the office area. The smoke/carbon monoxide detectors are hardwired and interconnected. At 11:05am smoke/carbon monoxide detectors were tested and observed to be functional. The fire extinguisher is located in the hallway and was purchased on 09/25/2025. Facility conducts quarterly fire drills, the last fire drill was done on 10/05/2025. The auditory alarms on all exit doors were functional at the time of the visit. Common Areas: These included the living room and dining room. There is a television set, gaming area and a covered fireplace in the living room. The common areas were properly furnished with tables and chairs for the number of residents. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient supply of perishable (2 days) and non-perishable (7 days) foods at the facility. Chemicals and detergents were stored in a locked cabinet in the hallway, next to the living room. Knives were stored in a kitchen drawer but LPA observed a small scissors and a large, sharp knife in a drawer. Staff immediately removed and locked the sharp objects; a citation will be provided. Continued on LIC809-C Bedrooms: There were six (6) bedrooms, five (5) of which are designated for residents' use. Currently bedroom #2 is vacant. Bedroom# 6 is designated as staff room. All bedrooms are were properly furnished with appropriate beddings, chairs, cabinets, linens and have sufficient lighting. Bathrooms: There are two (2) bathrooms, one near the office and one across from bedrooms #2 and #3. LPA observed functional fixtures, grab bars and non-skid mats in each bathroom. Hot water temperature was measured at 107.2 and 112.6 degrees Fahrenheit. Surrounding Grounds: There were no bodies of water present. Pathways and exits were free of obstructions. There is a patio table with umbrella and chairs, in the backyard. There is a two car attached garage, which is currently used for storage. There are two exits near the office, both clearly marked with exit signs. The side exit, near the office has a ramp leading to the side street and is used as the main exit during emergencies. Laundry Room: A stacked washer/dryer was observed next to bedroom #2. Chemicals and detergents were locked in a cabinet in the hallway. Resident Files/Medications: LPA reviewed files for all five (5) residents for required documents. LPA observed the medications stored in a locked cabinet in the living room. Medications for three (3) residents were counted for accuracy of administration. LPA observed a complete first aid kit and the manual in the office cabinet. Staff Files: LPA also conducted a file review of staff records to insure forms and training are up to date and in compliance with licensing requirements. Pursuant to Title 22 Division 6 of the CA Code of Regulations, deficiencies were cited and appeal rights provided during the visit. Exit Interview conducted / A Copy of the Report Issued to the Administrator.the state’s words, verbatim · CDSS document, Oct 7, 2025

Type of visit: Required - 1 Year

On 10/12/24, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with house manager Rowena Bacucang and explained the purpose of today’s visit. Bucucan contacted administrator Tina Arutyunyan by telephone who was not able to be present for this visit. The facility is licensed to operate for six (6) non-ambulatory of which (1) may be bedridden. The facility is approved for (4) hospice residents. Currently, the facility has (4) residents in hospice care. The facility is a single-story structure located in a residential neighborhood. It consists of the following: five (5) resident's rooms, two (2) common bathrooms, a living area, a dining area, a kitchen, an outside patio area, and garage used for storage. LPA toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for resident personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured 109.0-degree F. A comfortable temperature of 73 degree was maintained in the facility. LPA observed the facility to be clean, sanitary, and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. Fire extinguishers were charged, smoke detectors and carbon monoxide were operable. A review of the Medication Administration Record (MAR) was maintained in order. The facility has conducted a disaster drill on 07/14/24. A landline telephone was in working condition. A review of staff CPR/First Aid training is current. Evaluation Report Continues LIC 809-C During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. All mandated inspection control posters were posted. The facility is current on Community Care Licensing annual dues. An audit of residents #1-#6 (R1-R6) service files and staff #1-#4 (S1-S4) personnel files revealed to be complete. The facility has the current administrator's certification on file for Akop Ekmyan #7001640740 exp. 07/31/25. DEFICIENCIES: Resident room #4 is missing a window screen. Resident #4 is diagnosed with Dementia and (4) residents on hospice with no night shift "awake" staff. (2) stove burners and oven non-operable. Kitchen walls, ceiling and exhaust fan full of grease is unsanitary. Bathroom faucet and toilet flusher loose/not tight fitting require repair. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), the following deficiencies has been observed and citation issued (ref. LIC 809-D). An exit interview conducted with Rowen Bucucang, a copy of report and appeal rights provided. Note: *Citations not cleared by the due date will be a $100 fine assessed for each citation until it is cleared. Civil penalties will continue to accrue until Proof of Corrections (POC) are cleared. *the state’s words, verbatim · CDSS document, Oct 12, 2024

Allegation investigated: Neglect in supervision contributed to resident's death. Facility staff did not seek medical attention in a timely manner. Facility staff did not keep accurate records.

Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced subsequent complaint visit to this facility to complete investigation of the above allegations and to deliver final findings. LPA met with licensee, Rowena Bazucang, and explained the reason for the visit. --- Neglect in supervision contributed to resident's death. --- Facility staff did not seek medical attention in a timely manner. It was alleged that caregivers did not seek medical attention and did not call 911 in timely manner, which contributed to the death of resident #1 (R1). The investigation was initiated by the LPA Abeye Duguma on 01/31/24, at which time LPA inspected the facility and gathered R1’s facility records. The case was referred to CCLD Investigation Branch (IB) and investigation was continued by the Senior Investigator (SI) Sonia Sandoval. (CONT. on LIC9099-C) Unsubstantiated To investigate the allegations, on 03/12/24, Investigator Sandoval requested and reviewed R1’s medical and hospice records and interviewed facility staff members, residents and other witnesses, including police officers from the Burbank Police Department. The review of the hospice records revealed Resident #1 (R1) had a DNR on file. On 01/29/2024 at approximately 7:20a.m., hospice staff attended the facility after being informed of a change in R1’s condition and confirmed R1 had expired. The interviews of facility staff revealed at approximately 6:45a.m., staff reportedly discovered R1 unresponsive (not breathing or with no pulse). Staff #1 (S1) indicated the hospice nurse was immediately notified and several attempts were made to inform the responsible party. The interview of responsible party confirmed that on 01/29/2024 they had several missed calls (commencing at approximately 7:00a.m. hours) from the facility. Responsible party indicated when they called the facility back, they were informed R1 had passed away. The interview of Burbank Police Department Detective revealed the incident was not assigned for further investigation as the decedent was on hospice and there was no evidence of foul play observed by the responding officers. Based on interviews and record review, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. --- Facility staff did not keep accurate records. It was alleged that there was conflicting documentation at the facility regarding the resident. To investigate the allegation, LPA requested pertinent documents at 12:45p.m., and interviewed three (03) staff between 1:00p.m. to 02:40p.m. A review of the facility records clearly shows that the Physician Orders for Life-Sustaining Treatment have different dates on both documents. The Attempt Resuscitation was signed 08/20/2020 and the Do No Resuscitate was signed on 12/22/2022. LPA did not find any documentation in the resident’s file that contradicted these orders. During interviews with staff, all staff stated that resident had an Attempt Resuscitation order and that it was changed to Do No Resuscitate. Based on interviews and record review, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. No health and safety hazards were noted during the visit. Exit interview was conducted and a copy of report was issued.the state’s words, verbatim · CDSS document, Sep 25, 2024 · control 31-AS-20240130133804

Allegation investigated: Facility unaware of resident's condition. Facility did not seek medical attention in a timely manner.

On 01/03/24 at 1:26 p.m. Licensing Program Analyst (LPA) Evelin Rios conducted a subsequent complaint visit to this facility to conclude the investigation regarding the above allegations. LPA was greeted by staff, Rowene Bacucang who called the administrator Tina Arutyunyan to inform them LPA was at the facility. LPA informed the administrator the purpose of the visit. Administrator was unable to meet LPA at the facility and designated staff to sign todays report. During the course of the investigation, on 12/28/22, at 9:52 a.m. LPA interviewed three (3) out of six (6) residents in care. LPA conducted interviews with staff and the administrator from 10:12 a.m. to 11:12 a.m. LPA conducted a record review from 11:12 a.m. to 12:45 p.m. and obtained copies of pertinent information. On 12/30/22 from 9:30 a.m. to 10:12 a.m. LPA conducted follow-up interviews with two (2) out of two (2) staff in regards to the allegations above. From 10:12 a.m. to 11:15 a.m. LPA obtained more copies of pertinent information. From 10:51 a.m. to 11:01 a.m. LPA conducted a follow-up interview with the administrator. (Cont. on LIC9099C) Unsubstantiated Allegation #1: Facility unaware of resident's condition. In regards to the allegation, it was reported resident #1 (R1) had a medical emergency and staff could not provide paramedics with any of R1's medical information when requested. LPA's interview with staff #3 (S3) present during the events in question revealed they had called the administrator Tina to inform her of R1's change in condition at around 11:00 a.m. because she was fine during breakfast at around 8:30 a.m. According S3, Tina then called R1's Hospice nurse from Miracle Healing Hospice Inc. S3 goes on to state, Hospice nurse arrived at the facility around 3:00 p.m. and takes R1's vitals. At this time R1 has a fever of 104 degrees Fahrenheit and is not eating. The Hospice nurse instructs staff to give R1 Tylenol to reduce the fever and give oxygen. Hospice nurse tells staff to continue to observe R1's condition. According to S3 they call Tina and requests permission to call 911. S3 calls 911 at around 8:00 p.m. because R1's conditioned had not improved. According to S3 they were trying to give all the information requested by the paramedics but the paramedic was not allowing staff to explain. S3 goes on to say they believe their own accent could have been an issue. On 12/28/2023 LPA asked staff two (2) out of the three (3) staff to provide residents' primary diagnoses. LPA confirmed diagnoses with residents physician's report. LPA questioned staff where they would find residents' records and Hospice records. Staff were able to show LPA where resident files are stored. Based on the information obtained, although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is UNSUBSTANTIATED at this time. Allegation #2: Facility did not seek medical attention in a timely manner. In regards to the allegation, it was reported staff did not seek adequate medical attention or timely intervention for resident #1 (R1) which resulted in deterioration of R1. According to a reliable witness, R1 arrived to the emergency room and was not responding to stimuli. As reported by S3 they contacted the administrator first who then according to S3 and confirmed by the administrator they contacted the Hospice nurse. LPA reviewed R1's Hospice records which revealed R1 had been admitted to Hospice. LPA attempted to contact Hospice agency and Hospice nurse but was unsuccessful and did not receive a returned. Upon discharge R1 would be readmitted to the facility. On 01/03/24 LPA confirmed R1 is still at the facility, a resident re-appraisal and needs and services was conducted. LPA attempted to interview R1 on 01/03/24 at 2:50 p.m. According to Rowene, R1 has been improving and is eating regularly. According to interviews facility contacted Hospice first as directed to do so before calling 911. Based on the information obtained, although allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is UNSUBSTANTIATED at this time. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, Jan 3, 2024 · control 28-AS-20221219161213