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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850163
Report Date: 03/28/2024
Date Signed: 03/28/2024 10:04:20 AM


Document Has Been Signed on 03/28/2024 10:04 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
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:
03/28/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:David Abramyan TIME COMPLETED:
10:15 AM
NARRATIVE
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Licensing Program Analyst (LPA) Emily Peraldi conducted an unannounced case management visit at the above location. At 9:32 a.m., the LPA met with staff and explained the reason for the visit. At 9:50 a.m., staff David Abramyan arrived at the facility.

On 02/21/2024, a Notice of Operation in Violation of Law (NOVL) was issued due to the Licensee selling the business prior to the change of ownership application completion and issuance of a new license. The Applicants explained that an application for a change of ownership was sent out on January 2024. At this time, the change of ownership application is still in process. During the time of the visit, David A. explained that the fire inspection is scheduled for tomorrow.

The purpose of the visit is to ensure there are no health and safety hazards. At 9:56 a.m., the LPA along with staff toured the facility. The LPA observed four (4) residents at this location. Perishable and non-perishable foods were observed and were sufficient.

Exit interview conducted. A copy of the report was provided.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily PeraldiTELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:
DATE: 03/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/28/2024
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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