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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603279
Report Date: 10/13/2022
Date Signed: 10/14/2022 08:19:26 AM


Document Has Been Signed on 10/14/2022 08:19 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



FACILITY NAME:BELMONT VILLAGE SABRE SPRINGSFACILITY NUMBER:
374603279
ADMINISTRATOR:INAN LINTONFACILITY TYPE:
740
ADDRESS:13075 EVENING CREEK DR STELEPHONE:
(858) 486-5020
CITY:SAN DIEGOSTATE: CAZIP CODE:
92128
CAPACITY:184CENSUS: 148DATE:
10/13/2022
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Executive Director, Tracy KneppleTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Natasha Persaud conducted an unannounced Case Management -Legal/Non-compliance visit. LPA met with Executive Director, Tracy Knepple and discussed the purpose of the visit, to conduct an inspection to ensure ongoing compliance with regulations and laws and ensure the health and safety of residents in care.

During today’s visit, LPA briefly toured the facility, observed residents in care, and provided consultation regarding Title 22 requirements. LPA discussed the following regulations: CCR - 87465 Incidental Medical and Dental Care; CCR - 87609 Allowable Health Conditions; CCR - 87411 Personnel Requirements; CCR -87616 Exceptions for Health Conditions. The Executive Director was debriefed on the regulations and there is an understanding of the regulations.

Based on today’s inspection, there were no deficiencies cited at this time in the areas evaluated. An exit interview was conducted and a copy of this report along with Licensee's Appeal Rights (LIC 9058 01/16) were provided to the Executive Director, Tracy Knepple whose signature below confirms receipt of these rights.

SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha PersaudTELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:
DATE: 10/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/13/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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