374603231-1-31-2024-08-AS-SJAB-D2P2N4-20240221163208

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603231
Report Date: 01/30/2024
Date Signed: 01/31/2024 08:32:26 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
01/25/2024 and conducted by Evaluator Iby Strong

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20240125155452

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:	01/30/2024
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Director of Resident Care Services Elizabeth Smith		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Licensee did not follow infection control protocol for scabies outbreak
Licensee did not treat for pests

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Iby Strong conducted an unannounced visit to initiate an investigation on the above-mentioned allegations. LPA identified herself and discussed the purpose of the visit with Director of Resident Care Services Elizabeth Smith.

On January 25, 2024, Community Care Licensing (CCL) received a complaint alleging licensee did not follow infection control protocol for scabies outbreak, and licensee did not treat for pest. During the investigation, LPA Strong collected pertinent resident records as well as facility documentation and conducted interviews.

According to allegation, the licensee did not follow infection control protocol resulting in multiple scabies outbreaks. According to staff interview, the facility has not had an outbreak of scabies since January of 2023. Records reviewed revealed that all residents associated to the January 2023 outbreak were treated for scabies by medical providers.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Iby Strong	TELEPHONE: 619-481-0846
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

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-20240125155452

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: 01/30/2024

NARRATIVE

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Interview with staff did reveal that in January of 2024 Resident 1 (R1) was suspected of having scabies and R1 was treated preventively. Records collected confirmed that R1 was treated for symptoms related to scabies. Interviews with staff also revealed they did receive training to counter the spread of scabies. Interview with outside source confirmed that facility followed public health guidance in eradicating the outbreak.

It was also alleged that licensee did not treat for bed bugs. On today’s date, LPA Strong conducted room inspections and did not observe any active bed bugs. Records collected also confirmed that facility has had pest control inspections and records confirmed there was no bed bug activity. Interview with multiple residents did not reveal any corroborating information to prove that facility has pests.

Based on LPA's interviews, observations and record reviews there is not a preponderance of evidence to prove alleged violation occurred, therefore the allegations are unsubstantiated. An exit interview was conducted with Director of Resident Care Services Elizabeth Smith to whom a copy of this report, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Iby Strong	TELEPHONE: 619-481-0846
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

LIC9099 (FAS) - (06/04)

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