<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107206861
Report Date: 05/07/2021
Date Signed: 05/07/2021 10:59:05 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/27/2020 and conducted by Evaluator Les Xiong
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20200727143428
FACILITY NAME:BELMAR VILLAFACILITY NUMBER:
107206861
ADMINISTRATOR:HRIPSIME MAKARYANFACILITY TYPE:
740
ADDRESS:2020 NORTH WEBER AVENUETELEPHONE:
(559) 486-5977
CITY:FRESNOSTATE: CAZIP CODE:
93705
CAPACITY:100CENSUS: DATE:
05/07/2021
UNANNOUNCEDTIME BEGAN:
10:16 AM
MET WITH:Hripsime (Kristina) MakaryanTIME COMPLETED:
12:17 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
• Facility staff do not assist residents with medications.
• Facility staff is not meeting residents' hygiene needs.
• Residents are left in soiled bedding for an extended period of time.
• Facility staff failed to seek medical attention for resident in a timely manner.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Consistent with federal guidelines and Executive Order issued by Governor Gavin Newsom to improve infection control and prevent the transmission of COVID-19 to our most vulnerable and high-risk residents, the Department conducted this inspection by phone. On this date Licensing Program Analyst (LPA) L. Xiong conducted a Complaint tele-visit to deliver investigation findings regarding the above allegation with Administrator Kristina Makaryan.

During the course of the investigation, the Department interviewed staff on duty and obtained and/or reviewed facility records. It was determined based on the interviews and records review that the above allegations are UNSUBSTANTIATED. There was no information to indicate facility staff do not assist residents with medications, facility staff is not meeting residents' hygiene needs, residents are left in soiled bedding for an extended period of time, and facility staff failed to seek medical attention for resident in a timely manner. 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.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Les Xiong
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2021
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 1