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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107206861
Report Date: 06/09/2022
Date Signed: 06/09/2022 02:20:40 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
07/12/2021 and conducted by Evaluator Les Xiong
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20210712110839
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:
06/09/2022
UNANNOUNCEDTIME BEGAN:
12:37 PM
MET WITH:Hripsime (Kristina) MakaryanTIME COMPLETED:
02:53 PM
ALLEGATION(S):
1
2
3
4
5
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7
8
9
Resident fell while in care.
Staff does not follow resident's diet restrictions.
Activities are not being provided to 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. 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: Resident fell while in care,
Staff does not follow resident's diet restrictions and Activities are not being provided to residents are UNFOUNDED. Records reviewed indicated death reports were reported to Community Care Licensing at time of death and were contributed from declining health due to existing health conditions; Medical records review indicated no mismanage of resident's medication, facility menu were developed by certified dietition to meet the needs for the resident as ordered by the resident's doctor. Activities are ceased during time of Covid-19 due to safety. Resident is ambulatory, independent and not a fall risk and doesn't require constant supervision.

This agency has investigated the complaint alleging Resident fell while in care,
Staff does not follow resident's diet restrictions and Activities are not being provided to 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: 06/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022
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
07/12/2021 and conducted by Evaluator Les Xiong
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20210712110839

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:
06/09/2022
UNANNOUNCEDTIME BEGAN:
12:37 PM
MET WITH:Hripsime (Kristina) MakaryanTIME COMPLETED:
02:53 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff mismanaged resident's medications.
Inadequate food service is being provided.
Lack of supervision resulting in residents wandering nude.
Facility did not execute emergency disaster plan to 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. LPA met with Kristina Makaryan, Administrator and informed her the purpose of the investigation. The Department has investigated the complaint alleging: Staff mismanaged resident's medications, Inadequate food service is being provided, Lack of supervision resulting in residents wandering nude and Facility did not execute emergency disaster plan to residents. Based on the interviews conducted and/or records review the above allegations are UNSUBSTANTIATED. 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: 06/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022
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