374603279-11-15-2022-08-AS-IESA-CLP54G-20221130183732

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603279
Report Date: 11/15/2022
Date Signed: 11/15/2022 02:17:56 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
09/26/2022 and conducted by Evaluator Vicky Williamson

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20220926115940

FACILITY NAME:	BELMONT VILLAGE SABRE SPRINGS		FACILITY NUMBER:	374603279
ADMINISTRATOR:	INAN LINTON		FACILITY TYPE:	740
ADDRESS:	13075 EVENING CREEK DR S		TELEPHONE:	(858) 486-5020
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92128
CAPACITY:	184	CENSUS: 154	DATE:	11/15/2022
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Tracy Knepple, Executive Director		TIME COMPLETED:	02:25 PM

ALLEGATION(S):

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Licensee did not keep centrally stored medications locked.
Licensee did not meet resident's incontinent care needs.
Licensee did not have a sufficient number of staff to meet resident needs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Vicky Williamson conducted a complaint visit to deliver findings on the above allegations. LPA was greeted by the receptionist and granted entry into the facility. LPA met with Tracy Knepple, Executive Director, and discussed the purpose of the visit.

The Department’s investigation consisted of interviews with staff, responsible parties, and review of records to include resident records. It was alleged that licensee did not keep centrally stored medications locked. It was reported that on 9/6/22, the Wellness Center located at the facility where the residents’ medication is stored and disbursed was left unlocked and no staff present.

Interviews with staff revealed that sometimes the doors to the Wellness Center are open and residents sit inside and wait for their medications to be disbursed to them. The medication carts that are located inside of the Wellness Center are always locked. Residents interview stated that they report to the Wellness Center to wait for their medication to be disbursed to them.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Vicky Williamson	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2022

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-20220926115940

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 SPRINGS	FACILITY NUMBER: 374603279
	VISIT DATE: 11/15/2022

NARRATIVE

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An interview with an outside source revealed that they were advised that the Wellness Center was unlocked and there were no staff present. Outside source stated that they have no proof and are unable to confirm if this incident occurred or not.

It was alleged that licensee did not meet resident's incontinent care needs. Information received indicated that on 9/23/22, at 9:46 am, Resident 1 (R1) was still in the bed and no one had come to get them up, dressed, and cleaned up from the night before and taken to breakfast. Staff admitted that there was a delay in R1 being cleaned up, dressed and taken to breakfast; however, staff denied that they were not meeting R1’s incontinent care needs.

Interviews revealed that residents requiring assistance with incontinence are changed/checked according to the Resident Assessment Plan, before and after meals, when getting up in the morning and before going to bed at night as well as throughout the night. Interviews conducted with responsible parties did not disclose concerns regarding incontinent care needs of residents. An interview with R1 did not disclose that they had any issues with staff assisting them with dressing or their incontinent care needs.

An interview with R2 revealed that they dress themselves sometimes due to a delay of about 10 to 15 minutes in staff arriving to their room; however, they enjoy dressing themselves.

It was reported that licensee did not have a sufficient number of staff to meet resident needs. Per Executive Director Tracy Knepple, there are 5 to 6 caregivers on the morning and evening shifts, 3 to 4 caregivers on the night shift, one nurse per each shift, and 2 to 3 med techs on the morning and evening shift. A nurse serves as the med tech on the night shift. There are five different wings at the facility. A review of records revealed that the average number of residents is 154, however the facility serves 184 residents.

Interviews with staff revealed that, although the morning shift is occasionally short staffed due to staff calling out sick, residents needs are being met. Residents interviewed acknowledged that there seems to be a shortage of staff sometimes, however the staff always assist them with their needs. Executive Director Tracy Knepple stated that Agencies are contacted to provide additional staff when needed.

The Department’s investigation found no confirmable evidence to support the allegations. Documentation and interviews conducted with staff, residents, responsible parties, outside sources provided no conclusive evidence to support the allegations.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Vicky Williamson	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2022

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20220926115940

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 SPRINGS	FACILITY NUMBER: 374603279
	VISIT DATE: 11/15/2022

NARRATIVE

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Based on record reviews and interviews, allegations are unsubstantiated. Although the allegations may have occurred or are valid, there is not a preponderance of the evidence to prove the alleged violations occurred. An exit interview was conducted with Tracy Knepple, Executive Director, the Licensee’s Appeal Rights (LIC 9058 01/16) along with a copy of this report was provided to Executive Director and the signature on this form confirms receipt of these rights.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Vicky Williamson	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2022

LIC9099 (FAS) - (06/04)

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