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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107206861
Report Date: 02/06/2025
Date Signed: 02/12/2025 01:54:13 PM

Unsubstantiated


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
03/07/2024 and conducted by Evaluator Sarah Hurt
COMPLAINT CONTROL NUMBER: 24-AS-20240307093604
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: 64DATE:
02/06/2025
UNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Administrator, Hripsime MakaryanTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff did not ensure that a resident was rotated in bed.
Staff did not ensure that a resident attended a doctor's appointment.
Staff did not allow a resident to use a physician of their choice.
Staff did not seek a resident timely medical attention.
Staff did not ensure that a resident received all meals.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sarah Hurt arrived at the facility unannounced on 02/04/2025 at 11:00 a.m. to investigate the above allegations. LPA met with facility Administrator, Hripsime Makaryan and explained the purpose for today’s visit.

Regarding the allegation Staff did not ensure that a resident was rotated in bed. Resident 1 was being cared for by facility staff, and also home health. Facility staff is trained on rotation of residents and was aware Resident 1 needed consistent rotation. Based on observation and interviews, it is undetermined whether or not the allegation occurred. 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.

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

DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025
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 5
Control Number 24-AS-20240307093604
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
VISIT DATE: 02/06/2025
NARRATIVE
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Regarding the allegation Staff did not ensure that a resident received all meals. LPA observed food being served to residents and residents eating in the dining hall. LPA interviewed four facility residents who stated they are served meals daily. Based on observation and interviews, it is undetermined whether or not the allegation occurred. 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.

Regarding the allegation Staff did not ensure that a resident attended a doctor's appointment. Resident 1 missed a doctors appointment on 03/05/2024. Administrator stated the transportation company the facility uses required 5 days advance before any medical appointments notice to transport residents. Administrator stated Resident 1 did not give the required 5 day advance notice before their medical appointment on 03/05/2024. Administrator stated they offered to assist with rescheduling Resident 1's medical appointment and they declined. Based on observation and interviews, it is undetermined whether or not the allegation occurred. 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.


Regarding the allegation Staff did not allow a resident to use a physician of their choice. Resident 1 signed a document titled " House Doctor Agreement" dated 02/23/2024 acknowledging the facility does encourage residents to keep their regular doctor. Based on interviews, and records reviewed it is undetermined whether or not the allegation occurred. 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.


Regarding the allegation Staff did not seek a resident timely medical attention. Resident 1 was admitted to home health almost immediately after being admitted to this facility. Home health called the ambulance on 03/06/2024 and resident was taken to the hospital. LPA was unable to contact Home health to verify the responsibility of the facility, and the responsibilities of home health nurses. Administrator stated they were not aware of any concerns with Resident 1's health that required immediate medical attention. Based on interviews, it is undetermined whether or not the allegation occurred. 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 are being cited Per Title 22 Regulations.

Exit interview conducted with Administrator, Hripsime Makaryan, and a copy of this report provided.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
03/07/2024 and conducted by Evaluator Sarah Hurt
COMPLAINT CONTROL NUMBER: 24-AS-20240307093604

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:
02/06/2025
UNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:TIME COMPLETED:
12:00 PM
ALLEGATION(S):
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2
3
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9
Staff did not ensure that a resident's call bell was within reach.
Staff did not ensure that a resident's floor was maintained clean.
Staff did not treat a resident with dignity and respect.
Staff did not give the resident alternatives to food that they are allergic to.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sarah Hurt arrived at the facility unannounced on 02/06/2025 at 09:00 a.m. to investigate the above allegations. LPA met with facility Administrator, Hripsime Makaryan and explained the purpose for today’s visit.


Regarding the allegation Staff did not ensure that a resident's call bell was within reach. Reporting party stated during a visit to the facility Resident 1's call button was out of reach and not accessible. LPA observed several residents call buttons including in rooms 301, 309, and 311 to be out of reach of residents.Based on interviews conducted, and observation, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

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

DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025
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 5
Control Number 24-AS-20240307093604
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
VISIT DATE: 02/06/2025
NARRATIVE
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Regarding the allegation Staff did not ensure that a resident's floor was maintained clean. Reporting Party stated they witnessed the floor of Resident 1's room to be dirty during a visit to the facility on 02/25/2024. LPA observed During a visit to the facility on 01/10/2025, several resident bedroom trash cans with no lids, and several piles of resident dirty laundry on the floor. Based on observation, and interviews the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. No citing issued on this substantiated allegations as the facility was cited on 02/04/2025 for a similar allegation, please see complaint control #24-AS-20240603163501 to view citing.

Regarding the allegation Staff did not treat a resident with dignity and respect. Reporting Party stated Resident 1 reported their brief was changed without any privacy and the door open. LPA observed Resident 2 wearing only a brief and no covering with the door open. Based on interviews conducted and LPA observation, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.



Regarding the allegation Staff did not give the resident alternatives to food that they are allergic to. Reporting Party stated Resident 1 has several food allergies and facility kitchen staff was not providing adequate food substitutions. LPA interviewed four facility residents who all stated at times they just don't eat because they do not like the facility food and are not given adequate substitutions. Based on interviews conducted the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. No citing issued on this substantiated allegations as the facility was cited on 02/04/2025 for a similar allegation, please see complaint control #24-AS-20240603163501 to view citing.


Exit interview conducted with Administrator, Hripsime Makaryan, and a copy of this report along with appeals rights provided.

SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 24-AS-20240307093604
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: 02/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/20/2025
Section Cited
CCR
87468.1
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87468.1 Personal Rights of Residents in All Facilities:(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(1) To be accorded dignity in their personal relationships with staff, residents, and other persons. The following requirement has not been met as evidenced by;
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Administrator will conduct training with staff on residents personal rights and privacy and submit to LPA by POC date of 02/20/2025.
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LPA observed Resident 2 in room with door open wearing only brief, which poses a potential, health, safety, or personal rights violation to residents in care.
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Type B
02/20/2025
Section Cited
CCR
87303(i)(1)
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87303 Maintenance and Operation (i) Facilities shall have signal systems which shall meet the following criteria:
(1) All facilities licensed for 16 or more and all residential facilities having separate floors or buildings shall have a signal system which shall: The following requirement was not met as evidenced by:
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Adminstator will submit a written plan on how to ensure residents have access to call lights, and submit to LPA by POC date 02/20/2025.
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LPA observed signal system call button to be out of reach for several facility residents, which poses a potential, 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: 02/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5