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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603279
Report Date: 03/26/2025
Date Signed: 03/26/2025 10:52:40 PM

Substantiated


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
03/18/2025 and conducted by Evaluator Natasha Persaud
COMPLAINT CONTROL NUMBER: 08-AS-20250318170800
FACILITY NAME:BELMONT VILLAGE SABRE SPRINGSFACILITY NUMBER:
374603279
ADMINISTRATOR:TRACY KNEPPLEFACILITY TYPE:
740
ADDRESS:13075 EVENING CREEK DR STELEPHONE:
(858) 486-5020
CITY:SAN DIEGOSTATE: CAZIP CODE:
92128
CAPACITY:184CENSUS: 154DATE:
03/26/2025
UNANNOUNCEDTIME BEGAN:
11:31 AM
MET WITH:Executive Director, Tracy KneppleTIME COMPLETED:
06:00 PM
ALLEGATION(S):
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Staff are not ensuring residents are provided with sufficient amounts of food
Staff provide dirty dishware to residents
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Natasha Persaud conducted an unannounced visit to commence a complaint investigation. LPA identified herself and discussed the allegations mentioned above with Executive Director, Tracy Knepple.

During the investigation, the facility was briefly toured, and interviews were conducted with staff, residents, and outside sources. It was alleged staff are not ensuring residents are provided with sufficient amounts of food in the memory care unit. Today, 03/26/25, LPA observed lunch being served to the residents. There was a hot food cart brought over by the main kitchen. The hot food cart contained large trays of different food items for the residents, which needed to be portioned out and served individually to each resident. Today, the hot food cart had a large tray of yams, roasted vegetables, and salmon. The salmon was shredded up into small pieces. Per the kitchen staff, the salmon is a 4oz fillet. The kitchen has been made aware to serve the items whole, unless there is a modified diet on file. Continued on an LIC 9099C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 08-AS-20250318170800
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 SABRE SPRINGS
FACILITY NUMBER: 374603279
VISIT DATE: 03/26/2025
NARRATIVE
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The Enrichment Leader in memory care has a menu order form and will ask each resident what they would like to eat. The Enrichment Leader will write everyone’s order on the form and provide the order form to the kitchen staff. The kitchen staff prepare the food and take it over to the memory care unit on a hot food cart. Staff interviews revealed once the food is brought over, they portion it out and serve it to the residents on a plate. However, staff stated there is not always sufficient amounts of food. For example, today, the salmon was shredded, and each side item was in a large tray, as well as the salmon. The caregiver had to ration out the amount of food on each resident plate to ensure all residents were provided food. LPA observed the staff paying attention to each food item they placed on each plate, while checking the dining room to see how many more residents needed a plate. If the salmon was served as a 4oz fillet, each resident would have received a decent size portion. However, due to kitchen staff cutting up the salmon as well as other food items, the staff have to try and ensure all residents receive a plate of food.

LPA observed the large trays after the food was served to the residents and noticed all the food items were finished. Staff confirmed there are times there is not enough food for all the residents and they will have to ask the kitchen staff to bring over more food. The kitchen staff will bring over more food, but it can take thirty (30) minutes. Staff added it’s difficult to have a resident with a Major Neurocognitive Disorder sit at the dining table while other residents are eating, and they must wait additional time. Staff explained due to the resident’s medical condition, they become fidgety and want to get up, which distracts them once the food arrives. Resident interviews confirmed there are times there isn’t enough food served. Outside sources also confirmed there are times during breakfast, lunch, and dinner that there isn’t enough food. Outside sources reported usually the breakfast time is the meal that typically has insufficient food, which was also confirmed by staff. Staff interviews revealed it can depend on which staff member is cooking that day and what they send over to memory care, instead of consistent meal portions. Staff and outside sources also confirmed the kitchen will send over a sandwich and cut each sandwich into pieces and that will be shared amongst residents. There are residents in memory care with a small appetite and some with a regular appetite. Therefore, residents should be served one daily serving as offered on the facility’s menu. The kitchen staff should be consistent with sending whole meals over to the memory care unit, to ensure each resident is provided the quantity necessary to meet the residents needs. Executive Director, Tracy Knepple explained the residents receive enough food to meet their nutritional value. If additional food is needed, the kitchen is always open and able to provide enough food to meet the residents needs. Continued on an LIC 9099C.

SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 08-AS-20250318170800
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 SABRE SPRINGS
FACILITY NUMBER: 374603279
VISIT DATE: 03/26/2025
NARRATIVE
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It was also alleged, staff provide dirty dishware to residents. It was reported cups contain lipstick stains and plates contain crusted food from previous use. Today, 03/26/25, during lunch service in the memory care unit, LPA observed staff taking clean plates and clean cups out of a plastic carrier, which was brought over by the kitchen staff. The items were previously washed and ready for resident use. LPA observed the staff taking the cups out and two (2) cups were placed to the side, due to having lipstick stains. Staff explained they do not serve the dirty dishware to residents. They send it back to the kitchen and make them aware. Staff also explained the dishwasher was broken for approximately one (1) to two (2) weeks and the three (3) sink method was performed. However, the dishwasher has already been repaired and the cups were dirty today, 03/26/25. Executive Director, Tracy Knepple explained staff are trained and if the item is unsafe they know not to provide it or serve it to the resident.

Based on LPA’s observations and interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be substantiated. California code of Regulations, Title 22, Division 6 & Chapter 8 are being cited on the attached LIC 9099D. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Executive Director, Tracy Knepple whose signature below confirms receipt of these rights.

SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 08-AS-20250318170800
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 SABRE SPRINGS
FACILITY NUMBER: 374603279
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/26/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/23/2025
Section Cited
CCR
87555(a)
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General Food Service Requirements. The total daily diet shall be...in the quantity necessary to meet the needs of the residents...meet the Recommended Dietary Allowances... All food shall be selected, stored, prepared and served in a safe and healthful manner.
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Executive Director stated training will be provided to staff regarding quantity necessary to meet the needs of the residents.
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This requirement is not met as evidenced by: Based on observations and interviews, the licensee did not ensure the food quantity met the needs for 25 out of 154 [R1-R25] residents, which poses a potential health and safety risk to residents in care.
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Type B
04/23/2025
Section Cited
CCR
87555(b)(30)
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General Food Service Requirements. All utensils used for eating and drinking and in preparation of food and drink, shall be cleaned and sanitized after each usage. This requirement is not met as evidenced by:
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Executive Director stated staff will be trained on proper cleaning and sanitation of utensils, dishware and cups.
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Based on observations and interviews, the licensee did not ensure cups were cleaned for 25 out of 154 [R1-R25] residents, which poses a potential health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4