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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107206861
Report Date: 10/11/2021
Date Signed: 10/11/2021 02:15:26 PM

Document Has Been Signed on 10/11/2021 02:15 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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
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:
10/11/2021
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
01:07 PM
MET WITH:Hripsime (Kristina) MakaryanTIME COMPLETED:
02:23 PM
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Today, an office meeting was conducted here at the Community Care Licensing, to discuss the high frequency of service calls to Fresno PD and residents with wandering tendancies and staff training. Present are Administrator, Kristina Makaryan, Anna Sahakyan, Assistant Administrator and Marina Isounts, CEO (via virtual), Regional Manager, Brenda White, Local Unit Manager, See Moua and Licensing Program Analyst, Les Xiong. Fresno PD were not present during this meeting.


Currently, the facility has 4 direct care givers, 1 med. tech, 1 LVN, 1 administrator, 1 activities coordinator, 1 housekeeper and 1 maintenance (7-9 staff), 3 caregivers during noc shift. Housekeeper, maintenance personnel are also training to provide care giving if needed.

Food is prepared by outside vendor and bring to the facility. Snacks are also prepare from outside vendor.


Please provide current staff schedule, outside food vendor contract, dietitian information and staff dementia training materials to Community Care Licensing by 10/25/21.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Les Xiong
LICENSING EVALUATOR SIGNATURE: DATE: 10/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/11/2021
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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