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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850163
Report Date: 05/02/2024
Date Signed: 05/02/2024 03:27:51 PM


Document Has Been Signed on 05/02/2024 03:27 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:
05/02/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
02:04 PM
MET WITH:David Abramyan, StaffTIME COMPLETED:
03:30 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 4 residents in care. LPA Yee was let into the home by Albert Omurkulov, Staff. Erna Gevorgyan, Administrator was contacted by Staff and David Abramyan, Staff and Spouse of the Applicant arrived at 2:21pm to conduct the visit. The reason for today's visit was explained.

On today's visit, LPA Yee toured the residents' bedrooms to observe and speak with the residents in care, reviewed the food supply and toured the facility inside and outside and interviewed David Abramyan to determine if there any of the residents have a change in medical condition.

All the residents were observed to be alert and visually looked to be well. All 4 residents were in bed watching television. Resident #2 also visited with a family member during this visit.

Food supply was reviewed and were sufficient. A recommendation was made to supplement the non-perishable foods with a few more cans of vegetables and proteins.

Per tour of the facility, inside and outside, the facility was observed to be clean. No visually obvious or immediate health and safety issues were observed.

Per interview with David Abramyan, none of the residents currently in care have had a change in their medical condition or have any issues getting their medication.

Exit interview was conducted.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Christine YeeTELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:
DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/02/2024
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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