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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700545
Report Date: 08/17/2022
Date Signed: 08/17/2022 11:49:47 AM


Document Has Been Signed on 08/17/2022 11:49 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:BETHESDA SENIOR CAREFACILITY NUMBER:
342700545
ADMINISTRATOR:BOSTANCHYAN, DAVIDFACILITY TYPE:
740
ADDRESS:8874 NIMBUS WAYTELEPHONE:
(916) 627-0305
CITY:ORANGEVALESTATE: CAZIP CODE:
95662
CAPACITY:6CENSUS: 6DATE:
08/17/2022
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:David Bostanchyan, LicenseeTIME COMPLETED:
11:30 AM
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An informal office meeting was held today, 8/17/2022, via Microsoft Teams to address topics listed in this report.

The following Licensing staff were present:
Licensing Program Manager (LPM) Laura Munoz and Licensing Program Analyst (LPA) Michael Hood

The following representatives present:
Licensee, David Bostanchyan

The following topics were covered during today's meeting:
  • Substantiated complaint allegations from 7/19/2022 pertaining to resident being left outside facility without supervision from staff and facility not reporting incident to CCL or responsible party

Facility agrees not to repeat actions that resulted in incident discussed in today's meeting. LPA may follow-up with Licensee to ensure all the information discussed in this meeting has been implemented.

An exit interview was conducted and a copy of this report will be provided to the facility via email. A copy will be signed and returned to CCL. The signature of the Licensee on this form acknowledges receipt of this document.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Michael HoodTELEPHONE: 916-531-7341
LICENSING EVALUATOR SIGNATURE:
DATE: 08/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/17/2022
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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