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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107206861
Report Date: 12/12/2023
Date Signed: 02/01/2024 02:46:33 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO ASC, 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
10/09/2023 and conducted by Evaluator Sarah Hurt
COMPLAINT CONTROL NUMBER: 24-AS-20231009152716
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: 71DATE:
12/12/2023
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Administrator, Hripsime, MakaryanTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff do not maintain the facility clean and sanitary at all times
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sarah Hurt and conducted an unannounced facility visit to deliver findings on the above allegations. LPA met with facility Administrator, Hripsime, Makaryan and explained the purpose of today's visit.

Regarding the allegation Staff do not maintain the facility clean and sanitary at all times. LPA observed a pile of dirty laundry along with other miscellaneous items including undergarments piled in the corner of Resident 1's bedroom. LPA also observed the room is malodorous and smells of urine. Based on LPA's observation, and records reviewed during this investigation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED at this time.
The following deficiencies are being cited Per Title 22 Regulations. Exit interview conducted with Administrator, Hripsime, Makaryan, and a copy of this report along with appeals rights provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2023
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 3
Control Number 24-AS-20231009152716
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO ASC, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: BELMAR VILLA
FACILITY NUMBER: 107206861
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/26/2023
Section Cited
CCR
87303(a)
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87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. The following requirement has not been met as evidenced by:
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Administrator will conduct In Service training with staff on resident room cleanliness, and submit proof to LPA by POC date of 12/13/23.
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Based on LPA observation Resident 1's room has a large pile of laundry in the corner, and smells of urine, which causes an immediate health, safety, or personal rights risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO ASC, 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
10/09/2023 and conducted by Evaluator Sarah Hurt
COMPLAINT CONTROL NUMBER: 24-AS-20231009152716

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: 71DATE:
12/12/2023
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Administrator, Hripsime, MakaryanTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff do not assist resident with grooming
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sarah Hurt and conducted an unannounced facility visit to deliver findings on the above allegations. LPA met with facility Administrator, Hripsime, and explained the purpose of todays visit.
Regarding the allegation Staff do not assist resident with grooming. Based on interviews conducted with staff, and resident family members it is unclear if Resident 1 is not being assisted with grooming.Resident 1 has an outside nurse/caregiver that assists her with grooming, dressing, and activitiies of daily living. Facility staff interviewed stated they only assist Resident 1 with activities of daily living when the outside caregiver is not present. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

No Deficiencies cited per Title 22 Regulations. Exit interview conducted and a copy of this report provided.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3