374603279-8-21-2024-08-AS-LTEZ-D8MVZD-20240830165233

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603279
Report Date: 08/21/2024
Date Signed: 08/21/2024 03:46:26 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
08/04/2024 and conducted by Evaluator Natasha Persaud

COMPLAINT CONTROL NUMBER: 08-AS-20240804095825

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: 157	DATE:	08/21/2024
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Executive Director, Tracy Knepple		TIME COMPLETED:	02:13 PM

ALLEGATION(S):

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Facility staff did not follow physician's orders

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Natasha Persaud conducted a complaint investigation regarding the above-mentioned allegation. LPA met with Executive Director, Tracy Knepple.

During the investigation, LPA toured the facility, reviewed records, and interviewed staff, residents, and outside sources. It was alleged the facility staff did not follow physician's orders. It was reported Resident #1’s (R1) Consistent Carbohydrate Diet (CCD) was not being followed. R1’s Physician’s Report dated 12/08/23 indicated R1 required a low no added salt diet. On 06/17/24, R1’s physician wrote an order for a “Low-carb diet and decaf coffee only.” The Executive Director (ED) explained the facility received a copy of the order and it’s entered in the computer system to alert the kitchen of the requirement. The ED’s interview revealed the facility offers six (6) diets and Low carbohydrate falls under the category of CCD. ED also explained the facility does not add salt to their food. Therefore, the physician’s report indicating no added salt is also being complied. Continued on an LIC 9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha Persaud	TELEPHONE: (619) 301-3594
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.

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20240804095825

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: 08/21/2024

NARRATIVE

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ED stated Belmont’s corporate staff and a dietician designed the menu to ensure all options are low carbohydrates, excluding the beverages and desserts. The ED explained the admission agreement outlines the diets offered at the facility, prior to the resident and/or responsible party signing. The Director Resident Care Services (DRCS) indicated all menu options have moderate carbohydrate amounts and is proportioned appropriately. R1 requires carbohydrates and the order does not state no carbohydrates.

DRCS confirmed the menu is tailored to accommodate a low carbohydrate diet for all residents. DRCS explained the facility does not offer a diabetic diet. Therefore, a resident would have to relocate to an appropriate facility that accommodates a diabetic diet. Outside source interviews revealed R1 was being served waffles with syrup, hamburgers, and baked potatoes. Outside source interviews also revealed R1 sits at the dining table and eats multiple sugar packets. The outside source would like the sugar packets removed from the table. However, that would be a violation of residents’ personal rights. DRCS confirmed the high sugar content items on the menu would be the beverages and desserts. The staff will offer sugar free options for beverages and desserts. However, they cannot force the resident to choose sugar free options, especially since the facility does not offer a diabetic diet. The Chef Manager’s interview revealed the menu offered to residents consists of no added salt and low carbohydrates. The Chef Manager also confirmed the portions are not the portion sizes served at a restaurant. The facility serves potatoes that are small, approximately 3oz; the waffles are mini size and only two (2) are served; and the burger is approximately 2-2.5 oz. Therefore, the resident can select any of the items due to the low carbohydrate content and portion size. Chef Manager also stated the server is aware of any special/modified diets and they will offer the resident sugar free syrup, other sugar free options, and will also try to persuade the resident to make good choices. However, the resident has personal rights and is allowed to choose any items. If the staff notice a resident isn’t making wise choices, such as ordering double portions then it’s reported to the nurse for follow up with the resident’s physician. There have been no issues with R1, they select their own meals and eat in the dining room. Facility’s correspondence dated 06/17/24 indicated R1’s responsible party wanted the facility to stop serving breads, pasta, cookies, potatoes, sugar packets, sugary drinks/desserts. However, R1 requires carbohydrates per the physician’s order. Also, R1 has the cognitive ability to make their own food choices. The facility is offering a low carbohydrate diet and R1 has the right to make their own choices.

During the course of the investigation, interviews were conducted, and records were reviewed. Investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegation. The allegation was deemed unsubstantiated. 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 whose signature below confirms receipt of these rights.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha Persaud	TELEPHONE: (619) 301-3594
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

LIC9099 (FAS) - (06/04)

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