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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107206861
Report Date: 10/28/2021
Date Signed: 10/29/2021 01:34:01 PM

Document Has Been Signed on 10/29/2021 01:34 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: 60DATE:
10/28/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:46 PM
MET WITH:Hripsime (Kristina) MakaryanTIME COMPLETED:
03:02 PM
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On this date Licensing Program Analyst (LPA) L. Xiong conducted a Health & Safety visit at the above facility. LPA met with Administrator, Kristina Makaryan and inform her the purpose of the visit.

Tour of facility was conducted. Residents were observed to be doing well - well groomed & dressed. Housekeeper was finishing facility cleaning and dinner was beginning to be served. There were 60 residents of which 3 were on hospice and 3 receive home health. Staff present are: 1 med. tech., 1 housekeeper, 1 receptionist, 4 caregivers and the administrator. COVID-19 guidelines are in place at the facility.

No immediate Health & Safety concerns were observed. No deficiency cited for this visit.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Les Xiong
LICENSING EVALUATOR SIGNATURE: DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/28/2021
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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