374603279-8-29-2025-08-AS-LTEZ-DPU3C5-20251229170722

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603279
Report Date: 08/28/2025
Date Signed: 08/29/2025 08:54:06 AM

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
08/22/2025 and conducted by Evaluator Nacole Patterson

COMPLAINT CONTROL NUMBER: 08-AS-20250822131655

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: 147	DATE:	08/28/2025
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Executive Director Tracy Knepple		TIME COMPLETED:	04:50 PM

ALLEGATION(S):

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Staff did not treat resident(s) with respect.
Staff left medication(s) in resident's room.
Resident left facility unassisted.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Nacole Patterson, Ramin Hashemi, and Janet Ngallo conducted an unannounced visit to initiate a complaint investigation and deliver findings regarding the above complaint allegations. LPAs introduced themselves and disclosed the purpose of the visit to Executive Director Tracy Knepple.

On 08/22/2025 it was alleged that staff did not treat resident(s) with respect, staff left medication(s) in a resident's room, and a resident left the facility unassisted. The Department’s investigation consisted of unannounced facility visits, interviews with facility staff, residents, outside sources, and records review.

Regarding the allegation, "Staff did not treat resident(s) with respect", it was alleged that staff mocked Resident 1 (R1) and made them feel uncomfortable. Staff interviews did not corroborate the allegation, as no staff informed of observing or having knowledge of a staff member engaging with a resident in an undignified way. Staff members interviewed denied that a resident or family member informed them of being treated poorly by any caregiver. (Continued on LIC9099 p.2)

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Nacole Patterson
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025

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-20250822131655

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: 08/28/2025

NARRATIVE

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(Continued from LIC9099 p.1)

Resident interviews did not corroborate the allegation. Residents stated that staff treated them well and expressed no concerns. R1 was interviewed during the facility visit and stated that staff treated them well. R1 did not express concerns about staff treating them disrespectfully; R1 stated they were happy with the care they received and stated they would change nothing about the care provided at the facility.

Outside source interviews did not corroborate the allegation. An outside advocacy agency familiar with the facility stated that they had no concerns regarding residents' being treated with dignity by staff. R1's Responsible Party informed that staff treated R1 very well and stated they had no concerns regarding staff treatment toward R1.

No records were found to give evidence to this allegation. Staff records were absent of write-ups regarding staff treating a resident without respect. Care notes for R1 were absent of any situations regarding lack of respect/dignity by staff.

LPAs directly observed resident care during the facility visit. LPAs observed staff assisting residents with programmed activities, in groups, and activities of daily living (ADLs). These observations include times when staff were unaware of the LPAs' presence. LPAs did not observe any staff member engage with a resident in a disrespectful way.

Regarding the allegation, "Staff left medication(s) in resident's room", it was alleged that unsecured medication was left in Resident 2 (R2)'s room. Staff interviews did not corroborate the allegation, as staff denied seeing any unsecured medications in a resident room who was unable to administer their own medications.

Resident interviews did not corroborate this allegation. Five (5) residents were interviewed regarding medications, 3 of whom informed they administered their own medications. One resident only received pro re nata (PRN) "as-needed" pain medications and informed that there were no issues. R2 refused interview, however, LPAs briefly observed R2's room and noted that no loose medications were observed in the room.

Two outside sources familiar with the facility were interviewed regarding medication administration. The outside sources did not express concerns about medication administration and had not been made aware of any medication issues.

(Continued on LIC9099 p.3)

SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Nacole Patterson
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20250822131655

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: 08/28/2025

NARRATIVE

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(Continued from LIC9099 p.2)

No records were found to give evidence to this allegation. Staff records were absent of write-ups regarding medications being left in a resident's room. R2's assessments revealed that R2 did not administer their own medications. Care notes for R2 during the timeframe of complaint were absent of any incidents where medications were found in R2's room. Notations existed in R2's Care Notes regarding missed medications, however those situations were due to R2's refusals of the medication pass.

Regarding the allegation, "Resident left facility unassisted", it was alleged that Resident 3 (R3) left the facility without required staff supervision. Staff involved in the incident informed that R3 possibly experienced an episode of delusion during the incident due to observing paranoid behaviors outside of R1's baseline. Staff interviews additionally revealed that R1 was able to leave the facility unassisted, however, due to staff's concerns regarding R1's mental state, staff accompanied R1 as they left the facility, and additional staff responded to their location as well as R3's responsible party and paramedics.

R3 was unable to be interviewed due to being out of the facility during the facility visit.

An outside advocacy agency familiar with the facility did not have concerns about residents leaving unassisted and had not been made aware of any situations where a resident left the facility without required supervision. This outside source also did not have concerns about general resident supervision at the facility.

Review of facility records revealed that the incident was reported as required. R3's Physician's Report did not indicate that R3 was unable to leave the facility unassisted. The incident report details were consistent with staff interviews that R3 was accompanied by staff when they left the facility. Facility records additionally revealed that R3 was not noted to require wearing a Wander Guard. R3's charting notes were consistent with staff statements regarding R3's episode of delusion, wanting to leave the facility, and staff accompanying them outside. R3's Charting Notes also showed that R3 was assisted in the community by staff.

Based on interviews, direct LPA observations and records review, a preponderance of evidence does not exist to prove that the alleged violations occurred, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted with Executive Director Tracy Knepple, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Nacole Patterson
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025

LIC9099 (FAS) - (06/04)

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