374604562-2-25-2026-08-AS-SJAB-DRTRHS-20260303120248

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604562
Report Date: 02/25/2026
Date Signed: 02/25/2026 02:15:26 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
04/04/2024 and conducted by Evaluator Janet Ngallo

COMPLAINT CONTROL NUMBER: 08-AS-20240404162417

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: 193	DATE:	02/25/2026
		UNANNOUNCED	TIME BEGAN:	11:50 AM
MET WITH:	Executive Director James Arp		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Neglect resulted in a resident sustaining unexplained injuries.
Staff overdosed a resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Janet Ngallo conducted an unannounced visit to deliver findings regarding the above mentioned allegations. LPA identified themselves and met with Executive Director James Arp to discuss the purpose of the visit and elements of the complaint.

On 04/04/2024, it was alleged that neglect resulted in a resident(R1) sustaining unexplained injuries, and that staff overdosed a resident. The department's investigation consisted of interviews and records review.

(Cont. on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Janet Ngallo
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2026

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-20240404162417

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: 02/25/2026

NARRATIVE

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(Cont. from LIC 9099)

Regarding the allegation that neglect resulted in a resident sustaining unexplained injuries, interviews did not corroborate the allegations. Interviews with facility staff and outside sources consistently described R1 as having fragile skin, a history of frequent falls, and episodes of combative and resistive behavior. Interviews stated that R1 was often combative during care, exhibited paranoia upon admission, and would swing their arms into objects, causing skin tears and often reopened previously dressed wounds. Staff reported that R1's hospice provider visited twice weekly to provide wound care, and both hospice and facility staff provided ongoing dressing changes throughout R1's time at the facility. Outside source interviews stated that R1 experienced multiple falls, and had skin tears that were not related to abuse or neglect but instead were consistent with R1’s condition and behaviors.

Records review of R1's physician's report revealed that R1 had advanced dementia with recent significant progression and had a high fall risk. The report documented episodes of refusal of care, verbal aggression, and the need for fall-prevention measures. Records review of Hospice visit notes documented almost daily falls due to R1's difficulty rising from seated positions. Visit notes also documented ongoing paranoia and aggression, including an incident in which R1 struck a caregiver. No evidence supports that R1's injuries resulted from neglect. Injuries were consistent with the resident’s diagnosis, behaviors, fall history, and skin condition.

Regarding the allegation that staff overdosed R1, interviews and records review did not support that staff over-medicated R1. Interviews reported that R1 exhibited significant anxiety, agitation, and aggressive behaviors, and that all medications were administered under hospice orders. Hospice ordered the facility to adjust dosages of R1's medication based on R1's response and any side effects. Interviews stated that R1 was prescribed Lorazepam for anxiety and shortness of breath, and that sedation and reduced activity were known side effects.

(Cont. on LIC 9099-C pg. 1)

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Janet Ngallo
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 08-AS-20240404162417

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: 02/25/2026

NARRATIVE

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(Cont. from LIC 9099-C)

Records review of the Medication Administration Record showed that R1 received lorazepam on an as-needed basis, with no more than one administration per day, and often administered non-consecutively. The prescribed order instructed staff to administer one tablet every four hours as needed. Records review of R1's hospice visit notes revealed that hospice initiated trials of certain medications to address the resident’s significant agitation and anxiety, and dosages were adjusted accordingly when sedation or other side effects were observed. R1's responsible party requested that one trial medication be discontinued, and hospice discontinued the medication accordingly. No evidence corroborates concerns that staff administered medication inappropriately or beyond what was ordered.

Based on interviews 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 and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Executive Director James Arp, whose signature below confirms receipt of these rights.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Janet Ngallo
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2026

LIC9099 (FAS) - (06/04)

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