374603279-5-14-2025-08-AS-LTEZ-DKWQF3-20250826120712

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603279
Report Date: 05/14/2025
Date Signed: 05/14/2025 04:52:41 PM

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
03/27/2024 and conducted by Evaluator Natasha Persaud

COMPLAINT CONTROL NUMBER: 08-AS-20240327115517

FACILITY NAME:	BELMONT VILLAGE SABRE SPRINGS		FACILITY NUMBER:	374603279
ADMINISTRATOR:	TRACY KNEPPLE		FACILITY TYPE:	740
ADDRESS:	13075 EVENING CREEK DR S		TELEPHONE:	(858) 486-5020
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92128
CAPACITY:	184	CENSUS: 151	DATE:	05/14/2025
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Executive Director, Tracy Knepple		TIME COMPLETED:	03:40 PM

ALLEGATION(S):

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Neglect resulting in resident sustaining pressure injury
Neglect resulting in resident sustaining an infection in the mouth
Staff do not seek medical attention to residents in a timely manner
Residents are not treated with dignity
Facility does not provide activities for residents in care
Facility has rodents
Facility is in disrepair

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Natasha Persaud contacted the facility via telephone to commence a complaint investigation regarding the above-mentioned allegations. LPA spoke with Executive Director, Tracy Knepple and discussed the elements of the complaint.

Community Care Licensing (CCL) has investigated the above allegations. The investigation consisted of records review, interviews with facility staff, clients and outside agency and LPA observations.

It was reported to CCL neglect resulting in resident sustaining pressure injuries, neglect resulting in resident sustaining an infection in mouth, staff do not seek medical attention in a timely manner, residents are not treated with dignity, facility does not provide activities to residents in care, facility has rodents and facility is in disrepair. Continued on an LIC 9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2025

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-20240327115517

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: 05/14/2025

NARRATIVE

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Regarding the allegation, neglect resulting in resident sustaining pressure injuries, it was reported that Resident (R1) sustained pressure injuries as a result of the facilities’ neglect. A records review revealed a doctor’s note dated 5/22/2023 stating that R1 had stage 2 pressure injuries, and it was ordered that R1 was to receive wound care twice a week and be repositioned every two hours. Records review showed that hospice nurses visited R1 and provided wound care. Interview with outside source (OS1) revealed that R1 was provided wound care by hospice nurse and was repositioned by private caregiver. Interviews with facility staff revealed that staff reposition residents who are at risk of pressure injuries every two hours and reported no concerns for resident neglect.

Regarding the allegation, neglect resulting in resident sustaining an infection in mouth, it was reported that R2 sustained a rash in the mouth due to facility neglect. Records review revealed that R2 was prescribed medication Nystatin to treat infection in mouth and was seen by a Home Health agency. Records review show that there was a delay in getting the signed doctor’s order for the Nystatin due to the doctor’s office not sending over the order. Records review showed the facility advocating for the resident by calling the doctor’s office and requesting to follow up on doctor’s order. Interviews with facility staff revealed that staff had no concern for facility neglecting residents and reported that all residents are cared for. Interviews with residents revealed no concerns. Interview with outside source (OS2) revealed that staff reported the infection in R2’s mouth immediately and medical attention was sought out.

Regarding the allegation, staff did not seek medical attention in a timely manner, it was reported that residents have made complaints such as being in pain and staff do nothing. Interviews with facility staff revealed no concern for residents not receiving timely medical attention. Interviews with residents revealed no concern for delay in seeking medical attention. Interview with outside source (OS2) revealed no concern for residents not receiving timely medical attention.

Regarding the allegation, residents are not treated with dignity, it was reported that residents are not allowed to go outside. LPA conducted a walk through of facility and observed several doors that lead to outside area to be unlocked and accessible to residents. Interviews with staff revealed that residents are allowed to go outside, and facility has ample outside area for residents to utilize. Interviews with residents revealed that there is an outside area for residents to go to that is always available. Interview with outside source (OS1) revealed that facility has an outside area, and residents are able to go to outside area. Continued on an LIC 9099C.

SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2025

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20240327115517

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: 05/14/2025

NARRATIVE

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Regarding the allegation, facility does not provide activities to residents in care, it was reported that residents are not provided any activities. LPA observations revealed that an activities calendar is posted in multiple areas of the facility, including elevators, entrance of memory care and hallways. LPA observed morning exercise activity being conducted in memory care unit. Interviews with residents revealed that there are activities every day. Interviews with facility staff revealed that activities are offered daily and are changed every month.

Regarding the allegation, facility has rodents, it was reported that rodents have been found in the kitchen. LPA toured facility kitchen and did not observe any rodents or any indication that facility has rodents. Interviews with facility staff revealed no concern for rodents at the facility. Interviews with residents revealed no concern for rodents.

Regarding the allegation, facility is in disrepair, it was reported that the facility ceiling is leaky and moldy, there is owl feces leaking through the walls of the Casa Blanca Room, and resident 3 (R3)’s wall paint is chipping and in disrepair. LPA did not observe any leaky or molding areas in facility ceiling. LPA observed Casa Blanca Room (on bottom floor in memory care) and did not observe any owl feces leaking through walls. LPA observed R3’s room and observed wall paint to be intact and not chipping or peeling. LPA did not observe any concern for the building and grounds while conducting a walk through. Interviews with facility staff revealed no concerns for facility being in disrepair. Interviews with residents revealed no concern for building and grounds or cleanliness of facility. Interview with outside sources (OS1 & OS2) both revealed no concerns for building and grounds.

Based upon the foregoing, the above listed allegations are unsubstantiated. This finding means that the preponderance of the evidence standard has not been met, and the allegations are not valid. No deficiencies were cited today. 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 via email. [See LIC 811 Confidential Names List to identify Resident #1 and #2]

SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2025

LIC9099 (FAS) - (06/04)

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