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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850163
Report Date: 06/06/2023
Date Signed: 06/06/2023 09:57:01 AM


Document Has Been Signed on 06/06/2023 09:57 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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



FACILITY NAME:BELLAIRE SENIOR CARE, LLCFACILITY NUMBER:
195850163
ADMINISTRATOR:ELEN KIRAKOSYANFACILITY TYPE:
740
ADDRESS:6523 BALLAIRE AVETELEPHONE:
(818) 856-6980
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91606
CAPACITY:6CENSUS: 5DATE:
06/06/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Elen Kirakosyan and Ovsanna KhayalyanTIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA) Ashley Smith arrived unannounced to conduct a Case Management – Other visit, for the purposes of confirming ownership of this location. The LPA was allowed entry into the location by Venera Westernova. The LPA spoke with Administrator Elen Kirakosyan and explained the reason for the visit.

A Change of Ownership (CHOW) application was in process and had been initially accepted 10/10/2022, under the name and license number Bellaire Senior Care, LLC, 195850315. However, the Department received notification that this application was denied as of 05/25/2023. An interview with Administrator Elen Kirakosyan at 8:55 a.m. confirmed that the application for license number 195850315 was denied, and it was to be understood that Davit Hakobyan would continue to be the licensee. An interview was conducted with licensee Davit Hakobyan at 9:08 a.m., and Davit confirmed that they were still the licensee for this specific location and understood that the CHOW application was no longer in effect. The LPA explained that currently, Eva Terzian is listed as the elected member for the company Bellaire Senior Care, LLC on the Secretary of State website. Licensee Hakobyan explained that the change was made in anticipation of the CHOW application being approved but understood that they would need to resume responsibility and would become the appointed member for the company.

No immediate health or safety concerns observed during today’s visit.

Exit interview conducted with House Manager Ovsanna Khayalyan at 9:50 a.m. House Manager Khayalyan also confirmed that Davit Hakobyan is still the licensee at this time. House Manager Khayalyan showed the LPA the denial letter that was dated 5/25/2023.

A copy of the report was issued.

SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley SmithTELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:
DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/06/2023
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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