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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604562
Report Date: 04/30/2026
Date Signed: 04/30/2026 03:02:22 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
04/28/2026 and conducted by Evaluator Janet Ngallo
COMPLAINT CONTROL NUMBER: 08-AS-20260428103752
FACILITY NAME:BELMONT VILLAGE LA JOLLAFACILITY NUMBER:
374604562
ADMINISTRATOR:ARP, JAMESFACILITY TYPE:
740
ADDRESS:3880 NOBEL DRIVETELEPHONE:
(858) 450-2500
CITY:LA JOLLASTATE: CAZIP CODE:
92037
CAPACITY:220CENSUS: DATE:
04/30/2026
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Executive Director James ArpTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff neglected resident care resulting in rash.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Janet Ngallo conducted an unannounced visit to initiate a complaint investigation and deliver findings regarding the above-mentioned allegation. LPA identified themselves and met with Executive Director James Arp, to discuss the purpose of the visit and elements of the complaint.

On 04/28/2026, it was alleged that staff neglected a resident care resulting in a rash. The department's investigation consisted of LPA observations, interviews, and records review.

Regarding the allegation, interviews reported that the resident(R1) experienced a period of gastrointestinal symptoms that required frequent care and increased hygiene assistance. Staff reported that they were checking on R1 often, changing R1's continence products frequently, notified nursing staff when skin irritation was first observed, and treatment began promptly after. Staff also reported that R1 had a history of skin sensitivity.
(Cont. on LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Janet Ngallo
LICENSING EVALUATOR SIGNATURE:

DATE: 04/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 08-AS-20260428103752
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: 04/30/2026
NARRATIVE
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(Cont. from LIC 9099)

Records review of R1's physician's report revealed diagnoses of irritable bowel syndrome, and care plan revealed that R1 required assistance with changing continence products and personal hygiene. Communication logs from 04/10/2026–04/29/2026 showed frequent toileting checks, regular assistance with continence changes, and ongoing wellness checks. Review of R1's care plan notes indicated that staff reported the irritation, a follow-up medical appointment occurred, and treatment instructions were implemented. A physician’s order dated 04/27/2026 attributed the skin irritation to the resident’s gastrointestinal episode and directed increased care for R1.

LPA observed R1 clean and well-groomed. LPA attempted to interview R1, however due to cognition, R1 did not qualify for further interview.

Based upon the information obtained during this investigation, it is determined that the preponderance of evidence was not met to support or corroborate the allegation and therefore deemed unsubstantiated. An exit interview was conducted with Executive Director James Arp. A copy of this report and Licensee's Rights (LIC 9058 03/22) were provided and their signature on this report confirms receipt of the Licensee Rights.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Janet Ngallo
LICENSING EVALUATOR SIGNATURE:

DATE: 04/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2026
LIC9099 (FAS) - (06/04)
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