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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107206861
Report Date: 09/19/2024
Date Signed: 09/19/2024 02:28:54 PM

Document Has Been Signed on 09/19/2024 02:28 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/
DIRECTOR:
HRIPSIME MAKARYANFACILITY TYPE:
740
ADDRESS:2020 NORTH WEBER AVENUETELEPHONE:
(559) 486-5977
CITY:FRESNOSTATE: CAZIP CODE:
93705
CAPACITY: 100CENSUS: 65DATE:
09/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:03 AM
MET WITH:Hripsime "Kristina" MakaryanTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On 9/19/24, Licensing Program Analysts (LPA M. Medina conducted an unannounced Annual Required Inspection. LPA introduced self and stated purpose of visit. LPA met with and conducted facility tour with Administrator Hirpsime "Kristina" Makaryan.

Facility observed to be well lit, comfortable temperature, and odor free. Facility tour began in kitchen. LPA observed food facility to have adequate food supply for residents in care. Facility receives weekly food delivery. In addition to main pantry, facility has additional 7-day supply of emergency food and water available. All menus observed to be posted outside dining area.

A sample of resident bedrooms toured, of those toured, they were observed to have required furnishings available. Resident rooms have either shared or private restrooms. Of those toured, fixtures observed to be operational, water temperature measured at 108 degrees F. Shower rooms observed, to have shower chairs, non- skid mats, and grab bars available. All medications are locked and secured in Med room. Medications observed to have original labels and be administered as prescribed.

All cleaning supplies observed to be locked and secured. Janitorial carts, are locked and secured when not in use . Laundry room is locked and secured when not in use. Facility is equipped with pull stations and fire sprinklers throughout. Carbon monoxide detectors observed to be operational during facility tour. Fire extinguishers present with a service date of 1/10/24.

Hallways and exits observed to free of hazards.

Resident and staff files reviewed. All staff files reviewed have current First Aid and CPR, as well as required training. LPA received copies of the following during Annual Inspection, Administrator Certificate, Liability Insurance, LIC500, LIC610 and, LIC9020.

No deficiencies cited.

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.

LIC809 (FAS) - (06/04)
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