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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107206861
Report Date: 09/22/2021
Date Signed: 09/22/2021 02:59:24 PM

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
11/02/2020 and conducted by Evaluator Les Xiong
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20201102132659
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: 65DATE:
09/22/2021
UNANNOUNCEDTIME BEGAN:
01:07 PM
MET WITH:Hripsime MakaryanTIME COMPLETED:
03:53 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is dirty.
Facility is malodorous.
Facility did not maintain adequate staffing to meet the needs of residents.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) L. Xiong conducted the complaint investigation visit to the facility. During this visit LPA delivered investigation findings regarding the above allegations.The Department has investigated the complaint alleging: Facility is dirty, Facility is malodorous and Facility did not maintain adequate staffing to meet the needs of residents are UNSUBSTANTIATED. There were contradicting evidence and although the allegation may have happened or is 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: 09/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021
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 2
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
11/02/2020 and conducted by Evaluator Les Xiong
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20201102132659

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: 65DATE:
09/22/2021
UNANNOUNCEDTIME BEGAN:
01:07 PM
MET WITH:Hripsime MakaryanTIME COMPLETED:
03:53 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Unqualified staff are administering medication to residents.
Staff are not assisting residents with medication as needed.
Staff are not meeting showering needs of residents.
Staff did not provide meals to meet the needs of residents.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) L. Xiong conducted the complaint investigation visit to the facility.
During the course of this investigation LPA reviewed facility files and interview persons relevant to the complaint investigation. It was determined that the above allegation: Unqualified staff are administering medication to residents, Staff are not assisting residents with medication as needed, Staff are not meeting showering needs of residents, and Staff did not provide meals to meet the needs of residents are UNFOUNDED. Medical Tech were properly trained and medications were administered as per physicians' directions. Residents were scheduled and showered twice weekly or more often and meals were provided as per certified dietitian developed menu. This agency has investigated the complaint alleging (Unqualified staff are administering medication to residents, Staff are not assisting residents with medication as needed, Staff are not meeting showering needs of residents, and Staff did not provide meals to meet the needs of residents). We have found that the complaint was unfounded, therefore we have dismissed the complaint.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Les Xiong
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 2