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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107206861
Report Date: 09/19/2024
Date Signed: 09/20/2024 08:17:15 AM

Unsubstantiated


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
08/06/2024 and conducted by Evaluator Melinda Medina
COMPLAINT CONTROL NUMBER: 24-AS-20240806123513
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:
09/19/2024
UNANNOUNCEDTIME BEGAN:
02:36 PM
MET WITH:Hripsime "Kristina" MakaryanTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff speak to resident in an inappropriate manner
Staff does not provide resident medications as prescribed
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 9/19/24, Licensing Program Analyst (LPA) M. Medina conducted a subsequent unannounced complaint visit to conduct interviews and deliver findings. LPA introduced self, stated purpose of visit, and met with Administrator, Hripsime "Kristina" Makaryan

This department investigated the above allegations during the investigation, LPA toured facility, conducted interviews, and reviewed records.This department had insufficient information regarding the allegations listed above. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove or disprove that the allegations occurred therefore the allegations are UNSUBSTANTIATED.

No deficiencies issued during this complaint visit . Exit interview conducted. A copy of this report was provided to Administrator for facility records
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024
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
08/06/2024 and conducted by Evaluator Melinda Medina
COMPLAINT CONTROL NUMBER: 24-AS-20240806123513

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:
09/19/2024
UNANNOUNCEDTIME BEGAN:
02:36 PM
MET WITH:Hripsime "Kristina" MakaryanTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility has recurrent power outages causing resident to not have oxygen
Staff does not ensure resident's room is free of mold
Staff does not ensure resident's a/c vent is free of dirt
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 9/19/24, Licensing Program Analyst (LPA) M. Medina conducted a subsequent unannounced complaint visit to conduct interviews and deliver findings. LPA introduced self, stated purpose of visit, and met with Administrator, Hripsime "Kristina" Makaryan

During course of the investigation, facility was toured, records reviewed, and interviews conducted. This department investigated the allegation of facility has recurrent power outages causing resident to not have oxygen, staff does not ensure resident's room is free of mold, staff does not ensure resident's
a/c vent is free of dirt. During interviews, LPA was informed that facility has not had any power outages and facility is equipped with generator in case of emergency,and R1's oxygen is also equipped with battery pack. During facility tour, LPA did not observe R1's room to have mold and a/c vent observed to be clean.

This Department has found that the above allegations are UNFOUNDED, meaning they were false, could not have happened, and/or were without reasonable basis. We have therefore dismissed the complaint.

No deficiencies cited.

Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024
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