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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603279
Report Date: 08/21/2024
Date Signed: 08/21/2024 01:28:19 PM


Document Has Been Signed on 08/21/2024 01:28 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 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: 157DATE:
08/21/2024
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Tracy Knepple, Executive DirectorTIME COMPLETED:
01:35 PM
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Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced Collateral visit for an investigation unrelated to this facility. LPA identified herself and was granted entry by Diane Forsythe, concierge. LPA met with Tracy Knepple, Executive Director, and discussed the purpose of the visit.

During today’s visit, LPA requested and obtained records (see LIC811 Confidential Names list).

There were no deficiencies observed or cited during today’s visit.

An exit interview was conducted with Tracy Knepple, Executive Director, to whom a copy of this report, LIC811, and the Licensee/Appeal Rights (LIC9058 03/22) were provided at the conclusion of the visit. The signature below confirms the receipt of these documents.
SUPERVISOR'S NAME: Jennifer LottTELEPHONE: (619) -34-3976
LICENSING EVALUATOR NAME: Carmen LopezTELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:
DATE: 08/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/21/2024
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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