374603279-5-31-2024-08-AS-JLOT-D5T6G5-20240531204722

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603279
Report Date: 05/31/2024
Date Signed: 05/31/2024 03:35:10 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
01/20/2022 and conducted by Evaluator Liliana Silveira

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20220120172307

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: 134	DATE:	05/31/2024
		UNANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Executive Director Tracy Knepple		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Resident sustained fall due to lack of supervision.
Staff did not meet the residents assessed needs.
Care staff did not have required training.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Liliana Silveira conducted an unannounced complaint investigation visit. LPA Silveira introduced themselves, met with Executive Director Tracy Knepple and disclosed the purpose of the visit. The purpose of the visit was to deliver complaint findings for the above-mentioned allegations.

The Department’s investigation consisted of interviews with staff, residents and outside sources, as well as a facility records review. It was alleged that a Resident #1 (R1), who required assistance while toileting, was left alone in the bathroom by care staff in October 2021 and fell. A review of R1’s assessment records revealed that for October 2021, there was no fall registered for that month. Department interviews with residents who have lived at the facility since October 2021 demonstrated that residents had no concerns over staff not attending to their care needs. Interviews with care staff who worked during October 2021 revealed that there was no recollection of R1 having fallen during that month. Interviews with outside sources also revealed that there was no concern regarding resident’s care needs not being met. There was insufficient evidence to support this allegation. (CONTINUED ON NEXT PAGE, LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jennifer Lott	TELEPHONE: (619) 767-2311
LICENSING EVALUATOR NAME: Liliana Silveira	TELEPHONE: (619) 481-0844
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024

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-20220120172307

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: 05/31/2024

NARRATIVE

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(CONTINUED FROM LIC 9099) It was also alleged that R1 was not assisted out of bed in time for breakfast on 01/01/22 due to a lack of care staff being present at the facility. It was alleged that the facility did not have the appropriate number of care staff needed to meet residents’ care needs. A review of R1’s Physician’s Report and Department interviews with care staff who worked on 01/01/2022 revealed that R1 was able to use the call button when assistance was needed and was able to advocate for their own needs. An interview with an outside source revealed that R1 did not call for assistance on that day. An interview with the Executive Director regarding R1’s care needs revealed that sometimes, R1 was not interested in getting out of bed early and preferred to stay in bed and eat at lunchtime. Interviews with staff, residents and outside sources also revealed that there was no concern with the facility having a lack of staff on that date and during the month of January 2022. Interviews with the previous Executive Director, staff and outside sources also revealed that due to COVID-19 infection control protocols, staff were required to be sent home if they had symptoms or were sick during January 2022. The interviews revealed that while this caused an impact on care staff availability, it was not due to negligence and Agency staff were hired to fill in when needed. There was insufficient evidence to support this allegation.

Lastly, it was alleged that Care staff did not have required training from October 2021 to January 2022. Department interviews with residents who had resided at the facility during that period revealed that there was no concern regarding staff not being properly trained. Interviews with outside sources also revealed that there was no concern regarding a lack of training for care staff during that period of time. Outside sources also expressed that they were content with care staff services towards residents at the facility. A records review of training records for some of the care staff who worked during that timeframe revealed that staff had completed the required training. There was insufficient evidence to support this allegation.

Due to a lack of corroborating evidence, the allegations that a resident sustained a fall due to lack of supervision, that staff did not meet the residents assessed needs and that care staff did not have required training are unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations occurred, therefore the allegations are unsubstantiated.

LPA Silveira conducted an exit interview with Tracy. At the time of the exit interview Tracy was provided with a copy of the Complaint Investigation Report (LIC9099) and Licensee Rights (LIC9058 03/22). The signature on this report acknowledges receipt of the rights.

SUPERVISOR'S NAME: Jennifer Lott	TELEPHONE: (619) 767-2311
LICENSING EVALUATOR NAME: Liliana Silveira	TELEPHONE: (619) 481-0844
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024

LIC9099 (FAS) - (06/04)

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