195850068-8-6-2021-29-AS-DPEA-C79SSR-20210927140823

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850068
Report Date: 08/06/2021
Date Signed: 08/06/2021 11:54:07 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/23/2021 and conducted by Evaluator Brian Balisi

COMPLAINT CONTROL NUMBER: 29-AS-20210223163622

FACILITY NAME:	BELLAIRE SENIOR CARE LLC		FACILITY NUMBER:	195850068
ADMINISTRATOR:	BURSALYAN, KARPIS		FACILITY TYPE:	740
ADDRESS:	6523 BELLAIRE AVE		TELEPHONE:	(818) 688-1315
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91606
CAPACITY:	0	CENSUS: 0	DATE:	08/06/2021
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Oganes Duymlyan - House Manager		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Staff yell at residents in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPAs) Brian Balisi conducted a subsequent complaint visit to deliver final findings for the allegations listed above. LPA met with Oganes J Duymlyan and explained the reason for the visit. LPA spoke with Admin who stated Oganes can sign in their place.
During the course of the investigation, LPA conducted a physical plant tour virtually on 03/05/2021 as well as interviewed Administrator. On 7/27/21 LPA conducted interviews with facility staff and residents and gathered and reviewed facility documentation pertinent to the allegation.
It was alleged that staff yell at residents in care. LPA interview with (5) residents and (2) staff revealed that no one has ever witnessed any staff members yell at residents in care. All residents did not express any concerns for their health and safety while in the care of this facility at this time. Based on the information gathered during this and previous visits, the department does not have sufficient evidence to determine that Staff threatened resident while in care and staff hit a resident while in care. Therefore, the above allegation is UNSUBSTANTIATED at this time.
Exit interview conducted. Report issued and sent via email.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 08/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2021

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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