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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107206861
Report Date: 05/16/2022
Date Signed: 05/16/2022 02:12:17 PM

Unfounded


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
05/24/2021 and conducted by Evaluator Les Xiong
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20210524121408
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:
05/16/2022
UNANNOUNCEDTIME BEGAN:
01:43 PM
MET WITH:Hripsime (Kristina) MakaryanTIME COMPLETED:
02:44 PM
ALLEGATION(S):
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9
Staff did not have resident medically assessed in a timely manner after a fall.
Staff did not inform resident's family of a fall.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) L. Xiong conducted the complaint investigation visit to the facility. I met with Administrator Kristina Makaryan and informed her the purpose of the visit.
During the course of this investigation LPA reviewed facility files relevant to the complaint investigation. It was determined that the above allegations: Staff did not have resident medically assessed in a timely manner after a fall, and Staff did not inform resident's family of a fall are UNFOUNDED. The investigation indicated medical care provided and family notification was done timely. This agency has investigated the complaint alleging (Staff did not have resident medically assessed in a timely manner after a fall, and Staff did not inform resident's family of a fall). 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: 05/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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