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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850163
Report Date: 03/19/2024
Date Signed: 03/19/2024 03:20:21 PM


Document Has Been Signed on 03/19/2024 03:20 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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:BELLAIRE SENIOR CARE, LLCFACILITY NUMBER:
195850163
ADMINISTRATOR:ELEN KIRAKOSYANFACILITY TYPE:
740
ADDRESS:6523 BELLAIRE AVETELEPHONE:
(818) 856-6980
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91606
CAPACITY:6CENSUS: 4DATE:
03/19/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Erna Gevorgyan,AdministratorTIME COMPLETED:
03:25 PM
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Licensing Program Analyst(LPA), Christine Yee conducted an unannounced case management visit to check on the health and safety of the residents in care. LPA Yee met with Erna Gevorgyan, Administrator and the reason for today's visit was explained.

On today's visit, LPA Yee interviewed Erna Gervorgyan, Administrator to determine if there are any changes to any of the residents' condition or any changes that the Department should be made aware of regarding the facility. Per interview with the Administrator, there has been no changes in the residents condition or to the facility since the last visit conducted on 3/13/24. Residents #2 and Resident #4 were seen by their doctor on Saturday, 3/16/24 but were not given physician orders for the initiation of home health services. Per the Administrator, home health services are being requested for the 2 residents due to the difficulty of getting them to the doctor, need for additional showers and the need for lab work.

LPA Yee toured the bedrooms and visually observed the 4 residents in care. Per observation, all 4 residents were observed to be alert and doing well. Resident #1, #2 and #4 were in bed watching television and Resident #3 was relaxing in bed. Residents looked clean. Residents had lunch at noon. The living room, dining room and kitchen was observed to be clean. Food supply was inspected. Perishable foods were observed in the refrigerator and were sufficient but could be supplemented and non-perishable foods were not in quantities to last 7 days. Canned protein/meats, breakfast food, canned vegetables, snacks, pasta, sauces, bread need to be purchased in quantities to last a minimum of 7 days. Additional foods will be purchased today per the Administrator.The outside areas were toured and many of the boxes stored out under the covered patio had been cleaned since the last visit. General cleaning needs to be performed and all items stored in the outside areas and not in use should be stored or discarded.

The Administrator was reminded that they are not permitted to accept new admissions until a license has been obtained.
Exit interview was conducted.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Christine YeeTELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:
DATE: 03/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/19/2024
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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