374603279-9-26-2024-08-AS-LTEZ-D9HNE5-20240927102319

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603279
Report Date: 09/26/2024
Date Signed: 09/26/2024 04:27:59 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
08/22/2024 and conducted by Evaluator Natasha Persaud

COMPLAINT CONTROL NUMBER: 08-AS-20240822100509

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: 161	DATE:	09/26/2024
		UNANNOUNCED	TIME BEGAN:	11:46 AM
MET WITH:	Executive Director, Tracy Knepple		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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-Facility did not provide adequate food service resulting in resident becoming ill
-Facility is not clean and in good repair

INVESTIGATION FINDINGS:

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

During the investigation, records were reviewed, and interviews conducted with staff, residents, and outside sources. It was alleged the facility did not provide adequate food service resulting in resident becoming ill. An outside source reported that on 8/15/2024 around noon, they had lunch with their friend/resident at the facility. Both individuals became ill, with symptoms including vomiting and diarrhea, and it was suspected it was due to the salmon served at lunch. Neither individual sought medical attention nor were aware of anyone else getting sick. Multiple caregiver interviews revealed they eat the food served at the facility and have never gotten ill. The Chef Manager was observed on 08/28/24, eating the salmon served by the facility. The Chef Manager explained he eats the food all the time and loves the salmon and has never gotten ill. The Chef Manager also explained the food only sits in the warmer for two (2) hours or less. 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: 09/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024

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-20240822100509

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: 09/26/2024

NARRATIVE

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There are no concerns for bacteria or food poisoning. Resident interviews confirmed they have not gotten ill from the facility food. The Executive Director also confirmed eating the facility’s food on a regular basis and never gotten ill.

It was also alleged the facility is not clean and in good repair. An outside source reported that on 8/19/2024 they were informed that the kitchen was very dirty, and several kitchen equipment items were broken. The outside source confirmed they did not observe the kitchen. The Chef Manager’s interview revealed there was a Low Boy fridge out of service. The didn't use the Low Boy and it was thrown out and a new one was delivered within 2 weeks. The Chef Manager also stated the staff clean the kitchen daily, wiping down, sweeping, mopping, and sanitizing. LPA observed the kitchen on 08/28/24, all equipment was in good repair and working order, and the kitchen was clean. Residents were not interviewed because they do not enter the kitchen. The Executive Director (ED) stated if equipment is broken it’s immediately repaired or replaced. The ED confirmed the Low Boy fridge was broken and a new one was ordered and delivered on 07/31/24, which was prior to the reported date of incident.

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 allegations. The allegations were 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: 09/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024

LIC9099 (FAS) - (06/04)

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