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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107206861
Report Date: 10/13/2023
Date Signed: 10/13/2023 05:09:59 PM

Document Has Been Signed on 10/13/2023 05:09 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
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
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: 75DATE:
10/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:19 PM
MET WITH:Hripsime "Kristina" Makaryan, AdministratorTIME COMPLETED:
05:30 PM
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On 10/13/23 at 12:19 PM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct an Annual inspection. LPA explained reason for inspection and was granted entry by staff. Administrator (ADM) Hripsime "Kristina" Makaryan arrived approximately 30 minutes later.

LPA toured all halls of the facility. All sampled bedrooms observed with sufficient furniture and lighting. Facility set at comfortable temperature. Facility kitchen observed. Sufficient supply of perishable and non-perishable food observed. Centrally stored medication observed in wellness room. Sample of staff and resident files reviewed. Facility has an installed fire pull alarm system. Carbon monoxide detector located in kitchen tested and operational.

Due to time constraints, LPA will return on a later date to complete the Inspection Tool.

No deficiencies were cited during this inspection.

The following updated documents are to be submitted within 2 weeks:

LIC308, LIC500, LIC610E(new revision), LIC9020, Proof of liability insurance, LIC400, LIC402

An exit interview was conducted. A copy of this report was left with Administrator, whose signature confirms receipt of this report.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE: DATE: 10/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/13/2023
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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