374603231-10-17-2023-08-AS-DPOL-CX5MRA-20231031095002

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603231
Report Date: 10/17/2023
Date Signed: 10/17/2023 10:45:15 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/03/2021 and conducted by Evaluator Tiffany Holmes

COMPLAINT CONTROL NUMBER: 08-AS-20210803164339

FACILITY NAME:	BELMONT VILLAGE CARDIFF		FACILITY NUMBER:	374603231
ADMINISTRATOR:	ASHLEY MARCELLUS		FACILITY TYPE:	740
ADDRESS:	3535 MANCHESTER AVE		TELEPHONE:	(760) 436-8900
CITY:	CARDIFF BY THE SEA	STATE: CA	ZIP CODE:	92007
CAPACITY:	175	CENSUS: 140	DATE:	10/17/2023
		UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Ashley Marcellus, Administrator		TIME COMPLETED:	10:50 AM

ALLEGATION(S):

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Staff are not meeting residents hygiene needs
Staff are not responding to residents call buttons in a timely manner

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tiffany Holmes conducted an unannounced visit to close out the complaint investigation regarding the above-mentioned allegations. LPA identified herself and met with Ashley Marcellus Administrator, to discuss the purpose of the visit and elements of the complaint.

It was alleged that staff are not meeting residents hygiene needs. The Department's investigation included interviews, and a review of pertinent records, Interviews revealed the staff are meeting the residents needs by responding to them when they need something and assisting the residents with daily needs. Interviews revealed that the staff have been busy but the work with the residents is still getting done. The interviews revealed that the level of care is based on the individual residents care plans and that is how they determine how much assistance a resident needs. There were no witness statements that confirmed staff are not meeting residents hygiene needs.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Tiffany Holmes	TELEPHONE: (619) 481-0843
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2023

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 08-AS-20210803164339

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: BELMONT VILLAGE CARDIFF	FACILITY NUMBER: 374603231
	VISIT DATE: 10/17/2023

NARRATIVE

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It was alleged staff are not responding to residents call buttons in a timely manner. Interviews revealed the staff are responding to the call button although at times it is taking a little longer due to staff calling out. Interviews revealed that the facility is responding to the call button. Interviews with residents also revealed that some residents press the call button for things that are not very important and that does waste time for the staff to respond to a resident that may really need more assistance. There were no witness statements that confirmed staff are not responding to residents call buttons in a timely manner

The complaint allegations are unsubstantiated.

An exit interview was conducted with Ashley Marcellus, Administrator. A copy of this report and Licensee's Rights (LIC 9058 03/22) were provided and their signature on this report confirms receipt of the Licensee Rights.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Tiffany Holmes	TELEPHONE: (619) 481-0843
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2023

LIC9099 (FAS) - (06/04)

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