107206861-1-5-2024-24-AS-SMOA-CZASMQ-20240108130017

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107206861
Report Date: 01/03/2024
Date Signed: 01/05/2024 02:41:55 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 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
12/06/2023 and conducted by Evaluator Mai Yang

COMPLAINT CONTROL NUMBER: 24-AS-20231206111014

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: 69	DATE:	01/03/2024
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Hripsime "Kristina" Makaryan, Administrator		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff are mismanaging resident's medication.
Staff do not safeguard resident's personal items.
Staff did not address an inappropriate sexual interaction between residents.

INVESTIGATION FINDINGS:

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On 01/03/24, Licensing Program Analyst (LPA) M. Yang arrived unannounced to deliver findings on the
above allegations. LPA introduced self, stated the purpose of the visit, and met with Administrator Hripsime "Kristina" Makaryan.

During the course of the investigation, LPA conducted interviews, toured the facility, and reviewed records. R1’s medications were destroyed an hour after 4:00PM. R1 left the facility and did not return to facility until after 2 hours from the time R1’s 4:00PM medications were directed to be administered. Interviews were conducted, it was confirmed that R1’s door and/or doorknob had not been broken. The resident locks the door upon leaving the room and while in the room. The department investigated the allegation staff did not address an inappropriate sexual interaction between residents. Based on records reviewed and interviews conducted there was insufficient evidence to prove or disprove that there was an inappropriate sexual interaction that happened between R1 and R2. Based on interviews conducted, observation, and records reviewed, the preponderance of evidence standard has not been met, therefore, the above allegations are found to be UNSUBSTANTIATED. An exit interview was conducted. A copy of this report was provided to the Administrator.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: See Moua	TELEPHONE: (559) -65-7912
LICENSING EVALUATOR NAME: Mai Yang	TELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024

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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