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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850163
Report Date: 04/04/2024
Date Signed: 04/04/2024 03:14:58 PM


Document Has Been Signed on 04/04/2024 03:14 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:
04/04/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
01:33 PM
MET WITH:David AbramyanTIME COMPLETED:
03:20 PM
NARRATIVE
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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 during the application process. LPA Yee was let into the home by Albert Omurkulov, Staff. David Abramyan, Spouse of the Applicant was contacted via telephone by Staff and he arrived at 1:48pm to conduct the visit. The reason for today's visit was explained

On today's visit, LPA Yee interviewed David Abramyan to see if there has been any changes with the four residents in care and was advised that there has been no changes in any of the residents' condition. Medications were observed in a locked cupboard, food supply was reviewed and was sufficient for the four residents, however the facility did not have any emergency drinking water during the visit. Per David, water will be picked up later today. A tour of the 3 resident rooms was also conducted to observe the residents. Residents were observed in their beds watching television or sleeping. Visually they were all observed to be alert and doing well. During the visit, Resident #3's shower person from the hospice agency arrived to provide bathing services but the resident refused to be bathed. Resident #2's family also visited during today's visit.

Utilities were observed in use during the visit. Overall, the facility was clean and no visually obvious safety issues were noted.

Exit interview was conducted.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Christine YeeTELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:
DATE: 04/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/04/2024
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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