198601646-8-20-2026-11-AS-PMAA-DXXUY2-20260915155909

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601646
Report Date: 08/20/2026
Date Signed: 08/20/2026 02:12:27 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/11/2026 and conducted by Evaluator Bernadette Allen

COMPLAINT CONTROL NUMBER: 11-AS-20260811081318

FACILITY NAME:	BELMONT VILLAGE RANCHO PALOS VERDES		FACILITY NUMBER:	198601646
ADMINISTRATOR:	BALBIN, RALPH		FACILITY TYPE:	740
ADDRESS:	5701 CRESTRIDGE RD		TELEPHONE:	(310) 377-9977
CITY:	RANCHO PALOS VERDES	STATE: CA	ZIP CODE:	90275
CAPACITY:	150	CENSUS: 121	DATE:	08/20/2026
		UNANNOUNCED	TIME BEGAN:	08:25 AM
MET WITH:	Ralph Balbin-Administrator		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff are not providing adequate food service to resident
Staff are not treating resident with dignity and respect

INVESTIGATION FINDINGS:

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On 8/20/2026, Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to initiate and deliver findings for the alleged allegations. LPA identified herself and met Ralph Balbin Administrator who was informed of the purpose of the visit.

The investigation consisted of the following:

At 8:35 AM, the Department requested and reviewed the following documents: Staff Roster (LIC 500), Resident Roster, monthly menu and alternative menu, and weekly food purchase invoices. The Department also conducted a tour of the kitchen and dining area. During the tour, the Department observed a variety of food being served that appeared balanced and well-presented, which included bacon, sausage, waffles, eggs, pancakes, toast, omelets, mixed fruit, strawberries, coffee, juice, and milk. Additionally, the Department conducted interviews with Staff Members 1–5 (S1–S5); attempted interviews with Residents 1–2 (R1–R2); successfully interviewed Residents 3–6 (R3–R6); and interviewed Witnesses 1–2 (W1–W2).

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20260811081318

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: BELMONT VILLAGE RANCHO PALOS VERDES	FACILITY NUMBER: 198601646
	VISIT DATE: 08/20/2026

NARRATIVE

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The investigation revealed the following:

Allegation 1: Staff are not providing adequate food service to residents
Interviews conducted with Staff Members 1–5 (S1–S5) were asked if the staff provide adequate food service for the residents and 5 out of 5 staff members stated that residents’ meals are prepared according to their preferences, while also following balanced food group guidelines. Staff further stated that residents are provided with alternative meal options when requested. When asked if presentation is important, all five staff members stated yes, noting that meals are always served in a presentable manner. Staff also reported that if a meal is not presentable for any reason, it is replaced. The staff was also asked if any resident complained to them regarding their food all five said no one has complained.

The Department attempted interviews with Residents 1–2 (R1–R2), who were unable to engage in conversation. Residents 3–6 (R3–R6) were successfully interviewed and reported that staff provide adequate food service. When asked if their meals have ever been served in an unpresentable or undesirable manner, R3–R6 stated that the food has always been presentable, balanced and appropriate portions.
Interviews with Witnesses 1–2 (W1–W2) were also conducted. W1–W2 stated that staff provide adequate food service and that Resident 1’s meals have always been given in a presentable manner and there were no complaints.
Allegation 2: Staff are not treating residents with dignity and respect
Interviews were conducted with Staff Members 1–5 (S1–S5) and they were asked if staff members treat residents with dignity and respect and 5 out of 5 staff members stated residents are always treated with dignity and respect. When asked, has any resident ever complained to them about not being treated with dignity and respect and all five staff members stated they have not been informed of any such mistreatment.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20260811081318

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: BELMONT VILLAGE RANCHO PALOS VERDES	FACILITY NUMBER: 198601646
	VISIT DATE: 08/20/2026

NARRATIVE

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The Department attempted interviews with Residents 1–2 (R1–R2), who were unable to engage in conversation. Residents 3–6 (R3–R6) were successfully interviewed and reported that all staff members treat them with dignity and respect and that they have never been treated in a disrespectful manner by any staff member.
Interviews with Witnesses 1–2 (W1–W2) were also conducted. W1–W2 stated that staff have always treated R1 with dignity and respect. They further stated that all staff members are wonderful, helpful, and they have no complaints.

During the tour of the dining area during breakfast the department observed meals being served, which appeared to be presentable, balanced and appropriate portions. The department was also provided with a menu and invoices from Pavilions, Wholesum Breads, Alsco Uniforms, Sunrise Produce Sysco, which reflect a verity of perishables and non-perishables food items.

Based on observations, interviews conducted, and records reviewed, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are unsubstantiated.

An exit interview was conducted where this report was discussed and provided to Ralph Balbin Administrator at the conclusion of the visit.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2026

LIC9099 (FAS) - (06/04)

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