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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850163
Report Date: 04/11/2024
Date Signed: 04/11/2024 02:37:18 PM


Document Has Been Signed on 04/11/2024 02:37 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:
04/11/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
01:32 PM
MET WITH:Erna Gevorgyan,AdministratorTIME COMPLETED:
02:40 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. Also present during today visit was David Abramyan, Spouse of the Applicant

LPA Yee conducted a tour of the home, inside and outside, reviewed food supply, observed residents in care, and interviewed the Administrator to obtain update on any changes in the conditions of the residents or any new developments that could pose a danger to the health and safety of the residents.

Per information provided by the Administrator, there has been no changes to the residents' condition. Resident #2 and Resident #4 have received approval for home health services on 4/5/24 and was seen by the home health nurse today. Per tour of the resident rooms and observation of the residents, the residents were observed to be well and alert. Resident #1 was relaxing in bed, Resident #2 was initially observed sitting in the living room before returning to bedroom, Resident #3 was sitting up in bed watching television and Resident #4 was in bed napping. Residents indicated that they already had lunch. No obvious signs of health concerns were observed.

Per review of the food supply, sufficient perishable and non-perishable foods were observed, water was observed stored under the kitchen table. Staff was preparing spaghetti for tonight's dinner to be served with a salad. Utilities were observed in use.

Per tour of the facility, the inside and outside,f the facility was observed to clean but the outside could do with a little more attention, especially with discarding/storing unused furniture, chairs and equipment. No obvious safety issues were observed.

Exit interview was conducted.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Christine YeeTELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:
DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/11/2024
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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