107206861-5-19-2022-24-AS-SPIY-CEPP73-20220523110315

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107206861
Report Date: 05/16/2022
Date Signed: 05/19/2022 01:54:52 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
04/07/2021 and conducted by Evaluator Les Xiong

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20210407125945

FACILITY NAME:	BELMAR VILLA		FACILITY NUMBER:	107206861
ADMINISTRATOR:	HRIPSIME MAKARYAN		FACILITY TYPE:	740
ADDRESS:	2020 NORTH WEBER AVENUE		TELEPHONE:	(559) 486-5977
CITY:	FRESNO	STATE: CA	ZIP CODE:	93705
CAPACITY:	100	CENSUS:	DATE:	05/16/2022
		UNANNOUNCED	TIME BEGAN:	09:01 AM
MET WITH:	Hripsime (Kristina) Makaryan		TIME COMPLETED:	01:32 PM

ALLEGATION(S):

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9

Questionable deaths
Food service inadequate.
Staff are not trained.
Medication regulations are not adhered to.

INVESTIGATION FINDINGS:

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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: Questionable deaths, Food service inadequate, Staff are not trained and Medication regulations are not adhered to 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 residents and food were pureed when ordered by the resident's doctor, and all staffs were trained before having client contact. This agency has investigated the complaint alleging Questionable deaths, Food service inadequate, Staff are not trained and Medication regulations are not adhered to). We have found that the complaint was unfounded, therefore we have dismissed the complaint.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Les Xiong	TELEPHONE: (559) 410-1772
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2022

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
04/07/2021 and conducted by Evaluator Les Xiong

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20210407125945

FACILITY NAME:	BELMAR VILLA		FACILITY NUMBER:	107206861
ADMINISTRATOR:	HRIPSIME MAKARYAN		FACILITY TYPE:	740
ADDRESS:	2020 NORTH WEBER AVENUE		TELEPHONE:	(559) 486-5977
CITY:	FRESNO	STATE: CA	ZIP CODE:	93705
CAPACITY:	100	CENSUS:	DATE:	05/16/2022
		UNANNOUNCED	TIME BEGAN:	09:01 AM
MET WITH:	Hripsime (Kristina) Makaryan		TIME COMPLETED:	01:32 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Multiple Pressure injuries.
Staff are not assisted with managed incontinence.
Staff are not assisting residents with hygiene.

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. The Department has investigated the complaint alleging: Multiple Pressure injuries, Staff are not assisted with managed incontinence, and Staff are not assisting residents with hygiene. Based on the interviews conducted and/or records review the above allegations are UNSUBSTANTIATED. There were contradicting evidence and 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:

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Les Xiong	TELEPHONE: (559) 410-1772
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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