374604562-11-21-2025-08-AS-SMAZ-DQSUYK-20260129150003

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604562
Report Date: 11/21/2025
Date Signed: 11/21/2025 04:33:37 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
05/19/2025 and conducted by Evaluator Arian Golbakhsh

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20250519093916

FACILITY NAME:	BELMONT VILLAGE LA JOLLA		FACILITY NUMBER:	374604562
ADMINISTRATOR:	ARP, JAMES		FACILITY TYPE:	740
ADDRESS:	3880 NOBEL DRIVE		TELEPHONE:	(858) 450-2500
CITY:	LA JOLLA	STATE: CA	ZIP CODE:	92037
CAPACITY:	220	CENSUS: 186	DATE:	11/21/2025
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Executive Director James Arp		TIME COMPLETED:	04:35 PM

ALLEGATION(S):

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Staff do not respond to residents' calls for assistance in a timely manner.
Staff do not ensure residents' incontinence needs are being met.
Staff did not prevent resident from developing a pressure injury.
Unlawful eviction.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Arian Golbakhsh conducted an unannounced visit to conduct a complaint investigation and delivered findings regarding the above mentioned allegations. LPA was welcomed by, identified themselves to, and discussed the purpose of their visit to Executive Director James Arp.

On 05/19/2025, the Department received a complaint where it was alleged that the facility was not meeting the incontinence care needs of a resident (identified as R1) resulting in the development of pressure injuries. Additionally, the complaint alleges R1's calls for assistance are not responded to by staff in a timely manner and that R1 is being unlawfully evicted from the facility. The Department’s investigation consisted of unannounced facility visits, records review, and interviews with staff, residents, and outside sources.

R1 was a non-ambulatory resident at the facility with no diagnosis of cognitive impairment or Dementia, per their physician's report.

[Continued on LIC 9099-C]

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Arian Golbakhsh
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2025

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-20250519093916

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 LA JOLLA	FACILITY NUMBER: 374604562
	VISIT DATE: 11/21/2025

NARRATIVE

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[Continued from LIC 9099]

On April 21st, 2025, R1 was given a 30-day notice from the facility due to failure to follow facility rules, specifically for engaging in verbal abuse against staff and other instances of disruptive behavior in common areas. Initially a cease and desist, dated March 7th, 2025 was provided to R1, however R1's behaviors continued, and the facility issued the 30-day notice. An appeal meeting with R1 was held May 27th, 2025 and on June 6th, 2025 the facility provided R1 with a notice of the denied appeal and an unlawful detainer was filed. File review of over ten (10) staff member statements throughout April and May 2025 revealed a pattern of racial and derogatory statements being made by R1 towards staff. Staff interviews corroborated abusive behavior by R1, as well as multiple outside sources interviewed. The facility followed regulations regarding eviction procedures and failure to adhere to facility policies falls under the list of valid reasons for evictions, per regulation 87224.

Regarding the allegation of staff not preventing the development of R1's pressure injuries, review of R1's physician's report (dated September 2024) revealed R1 had no history of skin condition or breakdown and that R1 did not require continuous bed care. Interview with administrative staff revealed R1 had a history of pressure injuries and even had one prior to move in, which delayed R1's official move in as the facility requested the injury be treated and resolved before moving in. Review of R1's medical documents do note a history of stage 1 pressure injuries since 2020. Records reviewed revealed Home Health and Hospice treatment for R1's recurring pressure injuries from 2024-2025. Per staff interviews, though R1 was not formally bed bound (R1 is noted to be non-ambulatory on their physician's report) they spent most of their time in bed. Two (2) staff interviews corroborated that R1 had periodic sores in their genital area and facility staff would assist with applying ointments to the affected area(s) per instruction from Home Health. Home Health visit records note instructions for facility staff in care for the wounds. Interview with an outside source medical professional revealed that R1's diagnosed condition of Renal Disease contributes to the development of the pressure injuries. This interview also corroborated that facility staff assist in care for the injuries and keep the area clean.

[Continued on LIC 812-C]

SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Arian Golbakhsh
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2025

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20250519093916

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 LA JOLLA	FACILITY NUMBER: 374604562
	VISIT DATE: 11/21/2025

NARRATIVE

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[Continued from LIC 812-C]

Regarding the allegation of staff not ensuring R1's incontinence care needs are being met, this is also entwined with the allegation of staff not answering R1's pendant calls in a timely manner. Per the complaint, R1 would regularly wait over an hour and a half for staff to respond to their pendant calls and that R1 has sat in their feces for nearly four hours before staff changed their briefs. Multiple staff and outside source interviews revealed that R1 tends to "exaggerate" their claims on how long it takes to be tended to, when in reality it's only been several minutes. Two (2) staff interviews revealed that R1 specifically calls around shift changes in order to know who is working. Per staff interviews, during shift changes there is a brief staff meeting to pass over information, which then can cause a slight delay in responding to calls during that time.
Staff interviews revealed that as R1 is a two (2) person assist, it can take additional time for a secondary staff member to assist on a call if they are assisting someone else at the moment, one (1) mentioning that it on average takes up to 20 minutes to assist R1. The outside source medical professional interviewed revealed that there was no physical indication of R1 having been sitting in their stool for long periods of time as it would've been apparent on R1's pressure injuries. This interview also revealed that as R1 is fully incontinent, they cannot feel when they have had a bowel movement. Other residents interviewed revealed no concerns about the timeliness of staff responses to pendant calls or the speed of incontinence care. File review of R1's Needs & Services plan reveal that staff provide 3-4 brief checks per shift. File review of call button response logs for R1 for a span of three (3) months reveal that R1 utilized their call button on average ten (10) to fifteen (15) times a day and that the majority of calls were resolved within 25 minutes. However, on several occasions response times exceeded an hour, with two (2) being over 2 hours.

Based on interviews and records review, while the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred – therefore the allegations have been determined to be UNSUBSTANTIATED. An exit interview was conducted with Executive Director Arp to whom a copy of this report and the Licensee/Appeal Rights (LIC 9058) were provided. Their signature below confirms receipt of these documents.

SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Arian Golbakhsh
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2025

LIC9099 (FAS) - (06/04)

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