Belmar Villa

Type of visit: Required - 1 Year

On 09/09/2026, Licensing Program Analyst (LPA) V Gorban arrived at the facility unannounced to conduct Required Annual Inspection. LPA met with Administrator and Chief Operating Officer (AD) Christina Makaryan, certification number 7033107740, and expiration date 02/08/2028. LPA conducted tour inside and out of facility with AD. LPA observed residents at the facility during inspection time. The facility licensed for 100 residents comprised of 52 double occupancy rooms with a current census of 67 residents. Dining area and Kitchen were toured. Food delivered to the facility 6 days a week. An adequate supply of perishable and non-perishable food was observed to be properly stored in large walk in freezer (with temperature -0 degrees F),and large walk in refrigerator ( with temperature 38 degrees F), and pantry with perishable food reviewed by staff . Food is delivered by Cisco Foods twice a week. additionally, food delivered to the facility by Costco when needed. Fire extinguisher was observed with a service date of 08/21/2025. Per records, last emergency drill conducted on 01/09/2026 Residents' rooms were toured and observed with adequately furnished with bed, dresser, and adequate lighting. Hot water temperature tested and within regulation requirements. The facility contains 18-20 showers in different sections. LPA observed securely fastened grab bar and non-skid mats. Report continues on attached LIC809-C Medications were stored in a locked medication room. Facility use physical records for medication administration and records. Medications records were reviewed. First Aid Kit was stored in medication room and observed with all required items. Adequate PPE supplies was observed. LPA toured laundry room and observed chemicals were stored and locked for staff use only. Facility courtyard was toured and observed to be free from debris. There was outdoor seating available for the residents. Residents’ files were reviewed to have updated emergency contact, Admission agreement, Needs and Services Plan and Pre-Appraisal Plan. A sample of staff files were reviewed. Staff files were observed to have current First Aid/CPR, Health screening, and Personnel record. Staff are fingerprinted clear and associated to the facility. The facility telephone number 559-486-5977 observed operational. Community Care Licensing (CCL) is always striving to have facility files that reflect the most accurate & up to date information for your facility. In an effort to maintain your facility file, please submit the most current & complete forms &/or information as identified below: Residential Care Facility for the Elderly (RCFE): · LIC 308 Designation of Facility Responsibility · LIC 500 Personnel Report · LIC 9020 Register of Facility Clients/Residents Please submit the above forms/information to Fresno CCL by: 09/11/2026 As an operator of a Community Care Licensed facility it is your responsibility to be aware of and in compliance with all regulations, including Chaptered Legislation. Go to www.ccld.ca.gov to stay updated and informed. No deficiencies issued during this inspection. An exit interview was conducted with the AD. A copy of this report was given to the AD, whose signature on this form confirm receipt of this report.the state’s words, verbatim · CDSS document, Sep 9, 2026

Allegation investigated: Facility is not kept clean Staff are not administering medications as prescribed

On 04/15/2026 , Licensing Program Analyst (LPA) M. Medina conducted a subsequent unannounced complaint visit to complaint findings. LPA introduced self, stated purpose of visit, and met with Administrator, Hripsime "Kristina" Makaryan This department investigated the above allegations during the investigation, LPA toured facility, conducted interviews, and reviewed records. During facility tour, LPA observed facility to be odor free, floors observed clean, during interviews it was report that resident bedrooms are maintained daily by housekeeping. Review of medication administration record, documents that resident R1 received medication daily as prescribed unless absent from facility. This department had insufficient information regarding the allegations listed above. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove or disprove that the allegations occurred therefore the allegations are UNSUBSTANTIATED. No deficiencies issued during this complaint visit . Exit interview conducted. A copy of this report was provided to Administrator for facility records Unsubstantiatedthe state’s words, verbatim · CDSS document, Apr 15, 2026 · control 24-AS-20251112160503

Type of visit: Case Management - Annual Continuation

On 11/18/2025 Licensing Program Analysts (LPA) M. Medina conducted an unannounced Case Management Annual Continuation visit. LPA arrived, stated purpose of visit, and allowed entrance. LPA met with Administrator, Kristina Hripsime to conduct visit. . Annual continuation visit is being conducted to complete items from previous visit on 10/16/2025. Case management visit was a continuation for staff file review, resident records review, and a completion of the care tool. No deficiencies cited on this report. Licensee to submit the following updated documents to Fresno Regional office no later than 11/26/2025: Copy of liability insurance, LIC 500 (Personnel Report), and LIC 9020 (Register of Facility Clients/Residents) Exit interview conducted and facility report signed by Administrator and a copy provided for facility records.the state’s words, verbatim · CDSS document, Nov 18, 2025

Allegation investigated: Neglect/ Lack of Care/Supervision of Resident Facility does not provide snacks for residents in care.

On 10/16/25, Licensing Program Analyst (LPA) M. Medina conducted a subsequent unannounced complaint visit to conduct interviews and deliver findings. LPA introduced self, stated purpose of visit, and met with Administrator, Hripsime "Kristina" Makaryan This department investigated the above allegations during the investigation, LPA toured facility, conducted interviews, and reviewed records.This department had insufficient information regarding the allegations listed above. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove or disprove that the allegations occurred therefore the allegations are UNSUBSTANTIATED. No deficiencies issued during this complaint visit . Exit interview conducted. A copy of this report was provided to Administrator for facility records Unsubstantiatedthe state’s words, verbatim · CDSS document, Oct 16, 2025 · control 24-AS-20250626131858

Allegation investigated: Staff did not respond to resident's request for assistance in a timely manner. Staff stole resident’s personal belongings

On 10/16/25, Licensing Program Analyst (LPA) M. Medina conducted a subsequent unannounced complaint visit to conduct interviews and deliver findings. LPA introduced self, stated purpose of visit, and met with Administrator, Hripsime "Kristina" Makaryan This department investigated the above allegations during the investigation, LPA toured facility, conducted interviews, and reviewed records.This department had insufficient information regarding the allegations listed above. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove or disprove that the allegations occurred therefore the allegations are UNSUBSTANTIATED. No deficiencies issued during this complaint visit . Exit interview conducted. A copy of this report was provided to Administrator for facility records Unsubstantiatedthe state’s words, verbatim · CDSS document, Oct 16, 2025 · control 24-AS-20250530135326

Type of visit: Required - 1 Year

On 10/16/2025, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Annual Required inspection. LPA arrived, introduced self, stated purpose of visit, and allowed entrance into facility. LPA met with Administrator, Makaryan "Kristina" Hripsime to conduct facility tour and inspection visit. . LPA conducted facility tour with Administrator. Facility observed to be a comfortable temperature and odor free. Facility has a total of 52 bedrooms, bedrooms observed to have required furnishings, there is seating available throughout facility in the dining room, activity room, and lobby area. Facility has television sets in the lobby area and activity room. LPA observed resident bedrooms throughout the facility have televisions as well. Kitchen toured, LPA observed a 2-day supply of perishable foods and a 7-day supply of non-perishable food available. Facility receives food deliveries from both Sysco and Restaurant Depot for all food items 3x weekly. During facility residents observed to be seated outside on the patio, in the lobby watching television, engaged in activities with staff in the activities room and some relaxing in their bedrooms. A fire extinguisher is mounted on the wall of each home with a service date of 3/24/2025. The last fire drill was conducted 8/06/2025 Due to time constraints, medication review, review of resident and staff files, and completion of tool will be done at a later date. An exit interview was conducted with Administrator. A copy of this report was provided at the time of visit.the state’s words, verbatim · CDSS document, Oct 16, 2025

Type of visit: Case Management - Health Checks

On 06/04/25, Licensing Program Analysts (LPAs) M. Medina and J. Duarte conducted an unannounced Case Management visit for the purpose of Health and Safety of the residents in care. LPAs introduced self, stated the purpose of the visit and allowed entrance by Direct Care Staff. Administrator Hripsime "Krisitina" Makaryan was not available to conduct visit with LPAs. LPAs met with Administrative Assistant Hermine Makaryan during today's visit. LPAs conducted facility tour and interviews. Facility observed well lit and a comfortable temperature. LPAs observed residents throughout the facility in different areas. Food supply observed adequate for residents in care. Kitchen toured, LPAs observed a 2-day supply of perishable and a 7-day supply of non-perishable food available. All common areas observed to have adequate seating available for residents in care. Copies of R1 and R2 records received during case management visit. No deficiencies cited during case management visit,the state’s words, verbatim · CDSS document, Jun 13, 2025

Allegation investigated: Staff did not ensure that a resident was rotated in bed. Staff did not ensure that a resident attended a doctor's appointment. Staff did not allow a resident to use a physician of their choice. Staff did not seek a resident timely medical attention. Staff did not ensure that a resident received all meals.

Licensing Program Analyst (LPA) Sarah Hurt arrived at the facility unannounced on 02/04/2025 at 11:00 a.m. to investigate the above allegations. LPA met with facility Administrator, Hripsime Makaryan and explained the purpose for today’s visit. Regarding the allegation Staff did not ensure that a resident was rotated in bed. Resident 1 was being cared for by facility staff, and also home health. Facility staff is trained on rotation of residents and was aware Resident 1 needed consistent rotation. Based on observation and interviews, it is undetermined whether or not the allegation occurred. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Unsubstantiated Regarding the allegation Staff did not ensure that a resident received all meals. LPA observed food being served to residents and residents eating in the dining hall. LPA interviewed four facility residents who stated they are served meals daily. Based on observation and interviews, it is undetermined whether or not the allegation occurred. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Regarding the allegation Staff did not ensure that a resident attended a doctor's appointment. Resident 1 missed a doctors appointment on 03/05/2024. Administrator stated the transportation company the facility uses required 5 days advance before any medical appointments notice to transport residents. Administrator stated Resident 1 did not give the required 5 day advance notice before their medical appointment on 03/05/2024. Administrator stated they offered to assist with rescheduling Resident 1's medical appointment and they declined. Based on observation and interviews, it is undetermined whether or not the allegation occurred. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Regarding the allegation Staff did not allow a resident to use a physician of their choice. Resident 1 signed a document titled " House Doctor Agreement" dated 02/23/2024 acknowledging the facility does encourage residents to keep their regular doctor. Based on interviews, and records reviewed it is undetermined whether or not the allegation occurred. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Regarding the allegation Staff did not seek a resident timely medical attention. Resident 1 was admitted to home health almost immediately after being admitted to this facility. Home health called the ambulance on 03/06/2024 and resident was taken to the hospital. LPA was unable to contact Home health to verify the responsibility of the facility, and the responsibilities of home health nurses. Administrator stated they were not aware of any concerns with Resident 1's health that required immediate medical attention. Based on interviews, it is undetermined whether or not the allegation occurred. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. No deficiencies are being cited Per Title 22 Regulations. Exit interview conducted with Administrator, Hripsime Makaryan, and a copy of this report provided. Regarding the allegation Staff did not ensure that a resident's floor was maintained clean. Reporting Party stated they witnessed the floor of Resident 1's room to be dirty during a visit to the facility on 02/25/2024. LPA observed During a visit to the facility on 01/10/2025, several resident bedroom trash cans with no lids, and several piles of resident dirty laundry on the floor. Based on observation, and interviews the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. No citing issued on this substantiated allegations as the facility was cited on 02/04/2025 for a similar allegation, please see complaint control #24-AS-20240603163501 to view citing. Regarding the allegation Staff did not treat a resident with dignity and respect. Reporting Party stated Resident 1 reported their brief was changed without any privacy and the door open. LPA observed Resident 2 wearing only a brief and no covering with the door open. Based on interviews conducted and LPA observation, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Regarding the allegation Staff did not give the resident alternatives to food that they are allergic to. Reporting Party stated Resident 1 has several food allergies and facility kitchen staff was not providing adequate food substitutions. LPA interviewed four facility residents who all stated at times they just don't eat because they do not like the facility food and are not given adequate substitutions. Based on interviews conducted the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. No citing issued on this substantiated allegations as the facility was cited on 02/04/2025 for a similar allegation, please see complaint control #24-AS-20240603163501 to view citing. Exit interview conducted with Administrator, Hripsime Makaryan, and a copy of this report along with appeals rights provided.the state’s words, verbatim · CDSS document, Feb 6, 2025 · control 24-AS-20240307093604

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1 · Plan of correction due date: Feb 20, 2025

87468.1 Personal Rights of Residents in All Facilities:(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(1) To be accorded dignity in their personal relationships with staff, residents, and other persons. The following requirement has not been met as evidenced by; LPA observed Resident 2 in room with door open wearing only brief, which poses a potential, health, safety, or personal rights violation to residents in care.the state’s words, verbatim · CDSS document, Feb 6, 2025

Plan of correction: Administrator will conduct training with staff on residents personal rights and privacy and submit to LPA by POC date of 02/20/2025.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(i)(1) · Plan of correction due date: Feb 20, 2025

87303 Maintenance and Operation (i) Facilities shall have signal systems which shall meet the following criteria: (1) All facilities licensed for 16 or more and all residential facilities having separate floors or buildings shall have a signal system which shall: The following requirement was not met as evidenced by: LPA observed signal system call button to be out of reach for several facility residents, which poses a potential, health, safety, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Feb 6, 2025

Plan of correction: Adminstator will submit a written plan on how to ensure residents have access to call lights, and submit to LPA by POC date 02/20/2025.

Allegation investigated: Facility staff are not safeguarding residents' personal items

Licensing Program Analyst (LPA) Sarah Hurt arrived at the facility unannounced on 02/04/2025 at 11:00 a.m. to investigate the above allegations. LPA met with facility Administrator Administrator, Hripsime Makaryan and explained the purpose for today’s visit. Regarding the allegation Facility staff are not safeguarding residents' personal items. Reporting Party stated they believed Staff 1 were taking items from facility residents. Administrator stated Staff 1 was involved in a miscommunication at one time with a residents belongings but the belongings were recovered. Administrator stated Staff 1 still works at the facility and is a trusted employee. Based on interviews, it is undetermined whether or not the allegation occurred. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. No deficiencies are being cited Per Title 22 Regulations. Exit interview conducted with Administrator, Hripsime Makaryan, and a copy of this report provided. Unsubstantiated Regarding the allegation Food service is inadequate. Reporting Party stated the facility food is not adequate. LPA interviewed four facility residents who all stated at times they just don't eat because they do not like the facility food and are not given adequate substitutions. Based on interviews conducted the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. The following deficiencies are being cited Per Title 22 Regulations. Exit interview conducted with Administrator, Hripsime Makaryan, and a copy of this report provided.the state’s words, verbatim · CDSS document, Feb 4, 2025 · control 24-AS-20240603163501

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Feb 18, 2025

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. The following requirement has not been met as evidenced by: LPA Observed lifted flooring in resident bedroom, overflowing trash bins with no lids, and dirty laundry on resident bedroom floors, which poses a potential, health, safety, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Feb 4, 2025

Plan of correction: Administrator will send LPA proof of blinds fixed, window screen repaired, and lifted floor completely covered by 02/18/2024 POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(a) · Plan of correction due date: Feb 18, 2025

87555 General Food Service Requirements(a) The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and shall meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. All food shall be selected, stored, prepared and served in a safe and healthful manner. The following requirement has not been met as evidenced by: LPA interviewed 4 facility residents who all stated they do not feel the facilities food service is adequate, which poses a potential, health, safety, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Feb 4, 2025

Plan of correction: Administrator will submit proof of meeting with alert and oriented residents on the food options inside the facility, and the rule of requesting options two hours before food service, and send proof to LPA by POC date of 02/18/2025.

Allegation investigated: Staff speak to resident in an inappropriate manner Staff does not provide resident medications as prescribed

On 9/19/24, Licensing Program Analyst (LPA) M. Medina conducted a subsequent unannounced complaint visit to conduct interviews and deliver findings. LPA introduced self, stated purpose of visit, and met with Administrator, Hripsime "Kristina" Makaryan This department investigated the above allegations during the investigation, LPA toured facility, conducted interviews, and reviewed records.This department had insufficient information regarding the allegations listed above. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove or disprove that the allegations occurred therefore the allegations are UNSUBSTANTIATED. No deficiencies issued during this complaint visit . Exit interview conducted. A copy of this report was provided to Administrator for facility records Unsubstantiatedthe state’s words, verbatim · CDSS document, Sep 19, 2024 · control 24-AS-20240806123513

Type of visit: Required - 1 Year

On 9/19/24, Licensing Program Analysts (LPA M. Medina conducted an unannounced Annual Required Inspection. LPA introduced self and stated purpose of visit. LPA met with and conducted facility tour with Administrator Hirpsime "Kristina" Makaryan. Facility observed to be well lit, comfortable temperature, and odor free. Facility tour began in kitchen. LPA observed food facility to have adequate food supply for residents in care. Facility receives weekly food delivery. In addition to main pantry, facility has additional 7-day supply of emergency food and water available. All menus observed to be posted outside dining area. A sample of resident bedrooms toured, of those toured, they were observed to have required furnishings available. Resident rooms have either shared or private restrooms. Of those toured, fixtures observed to be operational, water temperature measured at 108 degrees F. Shower rooms observed, to have shower chairs, non- skid mats, and grab bars available. All medications are locked and secured in Med room. Medications observed to have original labels and be administered as prescribed. All cleaning supplies observed to be locked and secured. Janitorial carts, are locked and secured when not in use . Laundry room is locked and secured when not in use. Facility is equipped with pull stations and fire sprinklers throughout. Carbon monoxide detectors observed to be operational during facility tour. Fire extinguishers present with a service date of 1/10/24. Hallways and exits observed to free of hazards. Resident and staff files reviewed. All staff files reviewed have current First Aid and CPR, as well as required training. LPA received copies of the following during Annual Inspection, Administrator Certificate, Liability Insurance, LIC500, LIC610 and, LIC9020. No deficiencies cited.the state’s words, verbatim · CDSS document, Sep 19, 2024

Allegation investigated: Facility staff did not ensure restroom is clean and sanitized.

Licensing Program Analyst (LPA) Shawna Doucette conducted an unannounced facility visit to open a complaint on the allegations listed above. Administrator responded to the facility to assist with the visit. LPA met with Facility Adminsitrator, Makaryan Hripsime, and explained the purpose of today's visit. LPA toured the facility. LPA interviewed staff. LPA checked several bathrooms and two community bathrooms. LPA observed orangish pink and black mold in community shower. LPA took photos. LPA observed the in room bathrooms to be clean. Based on observation and interviews, Facility staff did not ensure restroom is clean and sanitized. Based on observation and interviews, the preponderance of evidence standard has been met; therefore, the above allegations are found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D. A copy of this report along with appeal rights and plan of correction were provided. Substantiatedthe state’s words, verbatim · CDSS document, Jul 10, 2024 · control 24-AS-20240502170130

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a)(1) · Plan of correction due date: Jul 12, 2024

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. (1) Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition. This requirement was not met as evidenced by Licensee did not keep community showers free from mold, which poses a potential health safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jul 10, 2024

Plan of correction: Licensee agrees to clean both community showers and submit photos by POC due date 7/12/24.

Type of visit: Office

On or about today's date, an office meeting was conducted at the Fresno Adult and Senior Regional Office. Present during the meeting are: Administrator, Kristina Makaryan, on the phone is facility President of the Marina Isounts, LPA Les Xiong and LPM Melinda Hoffmann. The meeting was scheduled due to the number of complaints and deficiencies the facility has had over the past year, three of which were type A deficiencies. The issues discussed during the meeting were: Lack of supervision, full bedrails, facility not maintained and sanitary, facility not meeting resident's care needs, staff not providing comfortable accommodations, staff not addressing resident's change of condition and no home health care plan for resident. Community Care Licensing would like to offer the facility Technical Support (TSP) if interested, to bring the facility back into substantial compliance.the state’s words, verbatim · CDSS document, Jun 28, 2024

Type of visit: Case Management - Incident

On 04/12/2024, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct a case management visit. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPA met with Administrator, Hripsime Makaryan. The purpose of today's visit is to follow up on an incident for R1. During today's visit, LPA reviewed the resident file. No deficiencies issued during today's inspection. Exit interview conducted. A copy of this report was discussed and provided to Administrator, Hripsime Makaryan, whose signature on this form confirms receipt of this document.the state’s words, verbatim · CDSS document, Apr 12, 2024

Allegation investigated: Facility staff did not provide supervision resulting in resident being left on the floor.

On 3/27/24, Licensing Program Analyst (LPA) V. Gorban visited the facility to deliver findings. During this visit LPA met with facility Administrator (AD) Hripsime Makaryan and stated the purpose of the visit. During this visit LPA toured the facility inside and out and observed residents in care. Once the tour was complete, LPA discussed the findings with the AD. Allegation: Facility staff did not provide supervision resulting in resident being left on the floor. During complaint investigation the LPA interviewed facility staff and the Administrator. Based off of records review, the Administrator and staff interviews resident was checked every thirty (30) minutes. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. Exit interview conducted, report signed and copy of this report provided to the Administrator for facility records. Unsubstantiatedthe state’s words, verbatim · CDSS document, Mar 27, 2024 · control 24-AS-20240108093021

Allegation investigated: Staff drugged a resident while in care Staff physically abused a resident while in care

On 3/27/24, Licensing Program Analyst (LPA) V. Gorban visited the facility to deliver findings. During this visit LPA met with facility Administrator (AD) Hripsime Makaryan and stated the purpose of the visit. During this visit LPA toured the facility inside and out and observed residents in care. Once the tour was complete, LPA discussed the findings with the AD. Allegation: Staff drugged a resident while in care. Based off of records review, the Administrator, staff interviews R1 was carring for her own medication. Allegation: Staff physicaly abused a resident while in care. Based off of the LPA observations, records review, facility personnel and residents interviews resident's care at the facility provided accordingly to resident's needs. Although the allegation may have happened or is valid, there are not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated. Exit interview conducted, report signed and copy of this report provided to the Administrator for facility records. Unsubstantiatedthe state’s words, verbatim · CDSS document, Mar 27, 2024 · control 24-AS-20240108142616

Allegation investigated: Due to lack of supervision resident eloped from the facility

On 03/13/2024 Licensing Program Analyst (LPA) B. Miranda arrived to the facility unannounced to deliver the finding for the allegations listed above. LPA introduced herself and explained the reason for the visit. Administrator (AD) Makaryan Hripsime (Kristina) was contacted. 1. The Department investigated the allegation: Due to lack of supervision resident eloped from the facility. On 2/9/2024 LPA spoke with AD who could not explain how R1 was able to elope from the facility without staff being aware R1 had left. LPA reviewed R1's physician report which indicates R1 is not able to leave the facility unassisted. AD stated when R1 was located they were sent to the hospital to be evaluated. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8, are being cited on the attached LIC 9099D. Exit interview was conducted and a copy of this report LIC9099 , LIC9099D, and appeal rights were provided to Administrator Makaryan Hripsime (Kristina). Substantiatedthe state’s words, verbatim · CDSS document, Mar 13, 2024 · control 24-AS-20240208123927

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1) · Plan of correction due date: Mar 14, 2024

87464 Basic Services (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). Health and Safety Code section 1569.2(c) provides: (c) "Care and supervision" means the facility assumes responsibility for, or provides or promises to provide in the future, ongoing assistance with activities of daily living without which the resident’s physical health, mental health, safety, or welfare would be endangered. Assistance includes assistance with taking medications, money management, or personal care. This requirement is not met as evidenced by: Based on observation, interview, and record review the licensee failed to follow physician orders by allowing the resident to elope from the facility unassisted. Facility did not know R1 left until R1's family arrived and was unable to locate R1 at the facility. This poses an immediate health, safety, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Mar 13, 2024

Plan of correction: On 2/9/2024 AD had created an hour check in log for staff to check on resident hourly. Administrator will provide a statement regarding changes made to prevent future elopements.

Allegation investigated: Missing medication

On 2/20/24, Licensing Program Analyst (LPA) M. Medina conducted an unannounced subsequent complaint visit to deliver findings. LPA introduced self and stated purpose of visit. Administrator contacted by telephone and arrived a short time later to conduct complaint visit with LPA. This Department investigated the allegation of missing medication for R1. Per record review and information gathered during interviews, R1 was able to manage their own medications per physicians report dated July 2023. R1 secured and administered their own medication. This Department has found that the above allegations are UNFOUNDED, meaning they were false, could not have happened, and/or were without reasonable basis. We have therefore dismissed the complaint. Nothe state’s words, verbatim · CDSS document, Feb 20, 2024 · control 24-AS-20231222160904

Allegation investigated: Facility is not meeting resident's care needs resulting in multiple falls causing bruising

On 01/23/2024, Licensing Program Analyst (LPA) Walton arrived unannounced to deliver findings on the above allegation. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. Front desk staff informed LPA that Administrator would arrive shortly and granted LPA access to a conferance room. Administrator, Hripsime Makaryan arrived a short time later. Review of records and interviews conducted revealed that R1 required 1:1 care and needed constant supervision. Interviews conducted confirmed that R1 did not receive 1:1 care from facility staff 24 hours a day, 7 days a week from 10/2023 - 12/2023. CONTINUED TO 9099C Substantiated Based on interviews and records review, the preponderance of evidence standard has been met, therefore the allegation: Facility is not meeting resident's care needs resulting in multiple falls causing bruising is SUBSTANTIATED. A deficiency is being issued in accordance to California Code of Regulations, Title 22, Division on the attached 9099D. Exit interview conducted and a plan of correction was reviewed and developed. A copy of this report and appeal rights were discussed and provided to Administrator, Hripsime Makaryan, whose signature on this form confirms receipt of this document.the state’s words, verbatim · CDSS document, Jan 23, 2024 · control 24-AS-20231004114010

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87705(c)(4) · Plan of correction due date: Jan 30, 2024

87705: (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following:(4)There is an adequate number of direct care staff to support each resident’s... safety and health care needs as identified in his/her current appraisal.. This requirement was not met as evidenced by: Based on interviews and record review, the licensee did not comply with section 87705 when the facility did not provide a 1:1 care staff to meet R1's needs as identified in R1's current appraisal, which is an potential health and safety risk to person's in care.the state’s words, verbatim · CDSS document, Jan 23, 2024

Plan of correction: Licensee agrees to submit a written statement detailing the steps the facility will take to ensure the requirements for section 87705 are met to the Fresno CCL office by the POC due date

Allegation investigated: Staff are mismanaging resident's medication. Staff do not safeguard resident's personal items. Staff did not address an inappropriate sexual interaction between residents.

On 01/03/24, Licensing Program Analyst (LPA) M. Yang arrived unannounced to deliver findings on the above allegations. LPA introduced self, stated the purpose of the visit, and met with Administrator Hripsime "Kristina" Makaryan. During the course of the investigation, LPA conducted interviews, toured the facility, and reviewed records. R1’s medications were destroyed an hour after 4:00PM. R1 left the facility and did not return to facility until after 2 hours from the time R1’s 4:00PM medications were directed to be administered. Interviews were conducted, it was confirmed that R1’s door and/or doorknob had not been broken. The resident locks the door upon leaving the room and while in the room. The department investigated the allegation staff did not address an inappropriate sexual interaction between residents. Based on records reviewed and interviews conducted there was insufficient evidence to prove or disprove that there was an inappropriate sexual interaction that happened between R1 and R2. Based on interviews conducted, observation, and records reviewed, the preponderance of evidence standard has not been met, therefore, the above allegations are found to be UNSUBSTANTIATED. An exit interview was conducted. A copy of this report was provided to the Administrator. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jan 3, 2024 · control 24-AS-20231206111014

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: Staff do not maintain the facility clean and sanitary at all times

Licensing Program Analyst (LPA) Sarah Hurt and conducted an unannounced facility visit to deliver findings on the above allegations. LPA met with facility Administrator, Hripsime, Makaryan and explained the purpose of today's visit. Regarding the allegation Staff do not maintain the facility clean and sanitary at all times. LPA observed a pile of dirty laundry along with other miscellaneous items including undergarments piled in the corner of Resident 1's bedroom. LPA also observed the room is malodorous and smells of urine. Based on LPA's observation, and records reviewed during this investigation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED at this time. The following deficiencies are being cited Per Title 22 Regulations. Exit interview conducted with Administrator, Hripsime, Makaryan, and a copy of this report along with appeals rights provided. Substantiatedthe state’s words, verbatim · CDSS document, Dec 12, 2023 · control 24-AS-20231009152716

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Dec 26, 2023

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. The following requirement has not been met as evidenced by: Based on LPA observation Resident 1's room has a large pile of laundry in the corner, and smells of urine, which causes an immediate health, safety, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Dec 12, 2023

Plan of correction: Administrator will conduct In Service training with staff on resident room cleanliness, and submit proof to LPA by POC date of 12/13/23.

Allegation investigated: Resident was restrained in bed

Licensing Program Analyst (LPA) Sarah Hurt and conducted an unannounced facility visit to deliver findings on the above allegations. LPA met with facility Administrator, Hripsime, Makaryan, and explained the purpose of the visit. Regarding the allegation Resident was restrained in bed. LPA Hurt observed Resident 1’s bed to have full bed rails. Resident 1 is not currently on hospice, and there is no written orders for full bed rails. LPA also reviewed photos documenting a mattress pad wedged between the full bed rails of Resident 1’s bed preventing them from getting out of bed. Based on LPA's observation, and records reviewed during this investigation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED at this time. The following Deficiencies are being cited Per Title Regulations. Exit interview conducted with Administrator, Hripsime, Makaryan, and a copy of this report along with appeals rights provided. Substantiatedthe state’s words, verbatim · CDSS document, Dec 12, 2023 · control 24-AS-20231201085752

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87608(a)(5) · Plan of correction due date: Dec 13, 2023

87608 Postural Supports (a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions. (5) Under no circumstances shall postural supports include tying, depriving, or limiting the use of a resident's hands or feet. (A) A bed rail that extends from the head half the length of the bed and used only for assistance with mobility shall be allowed.(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. The following requirement has not been met as evidenced by: Based on observation and records reviewed Resident 1 is not on hospice, but their bed has full bed rails, which poses an immediate, health, safety, or personal rights risk to resident in care.the state’s words, verbatim · CDSS document, Dec 12, 2023

Plan of correction: Administrator will remove the full bed rails from Resident 1's bed, and send proof to LPA by POC date of 12/13/2023.

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

On 11/28/23 at 12:57 PM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct a case management inspection regarding a Decision and Order to exclude S1. LPA explained reason for inspection and met with Administrator (ADM) Hripsime Makaryan. LPA confirmed with ADM S1 was not working in the facility. ADM stated S1 has not been working in the facility since earlier this year. No deficiencies cited during this inspection. Exit interview conducted. A copy of this report was given to Administrator, whose signature confirms receipt of this report.the state’s words, verbatim · CDSS document, Nov 28, 2023

Type of visit: Case Management - Annual Continuation

On 11/28/23 at 12:57 PM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct an Annual Continuation inspection. LPA explained reason for inspection and met with Administrator Hripsime Makaryan. LPA completed Inspection Tool. No deficiencies cited during this inspection. Exit interview conducted. A copy of this report was given to Administrator, whose signature confirms receipt of this report.the state’s words, verbatim · CDSS document, Nov 28, 2023

The state marks this report as 2 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.