374603231-9-27-2025-08-AS-SMOA-DLYMGJ-20250929093602

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603231
Report Date: 09/26/2025
Date Signed: 09/27/2025 11:40:54 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
04/04/2022 and conducted by Evaluator Sarah Hurt

COMPLAINT CONTROL NUMBER: 08-AS-20220404094758

FACILITY NAME:	BELMONT VILLAGE CARDIFF		FACILITY NUMBER:	374603231
ADMINISTRATOR:	ASHLEY MARCELLUS		FACILITY TYPE:	740
ADDRESS:	3535 MANCHESTER AVE		TELEPHONE:	(760) 436-8900
CITY:	CARDIFF BY THE SEA	STATE: CA	ZIP CODE:	92007
CAPACITY:	175	CENSUS: 151	DATE:	09/26/2025
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Executive Director, Wesley Lavender		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Resident developed unstageable wound due to neglect
Staff did not ensure medical care for resident
Facility retained resident who required higher level of care
Staff did not administer medications as prescribed

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sarah Hurt conducted a telephone call vmeeting/ visit on 09/26/2025 to deliver Complaint findings on the allegations listed above. LPA met with facility staff Wesley Lavender and explained the purpose of the phone meeting.

Regarding the allegation, Resident developed an unstageable wound due to neglect. Documents show Resident 1 developed a wound on the right forearm that progressed over time. Medical records attribute the wound to a separate diagnosed medical condition. Facility staff were not responsible for wound care; instead, AccentCare Home Health and Tri-City Medical Center provided ongoing treatment. Facility staff monitored and reported changes. Although the wound worsened, the evidence does not show that neglect by facility staff caused or contributed to the condition. Based on records reviewed, the allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged did or did not occur.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2025

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-20220404094758

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 CARDIFF	FACILITY NUMBER: 374603231
	VISIT DATE: 09/26/2025

NARRATIVE

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Regarding the allegation Staff did not ensure medical care for resident. Records confirm Resident 1 was under the care of Tri-City physicians and AccentCare Home Health nurses. Facility staff followed medical instructions and family also retained private caregivers. Allegations that staff failed to ensure medical care could not be corroborated with available documentation. Based on records reviewed, the allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged did or did not occur.

Regarding the allegation Facility retained resident who required higher level of care. Reporting party alleged Resident 1 should have been transferred to skilled nursing due to the wound. However, treating clinicians documented the wound required simple dressing changes and that Resident 1 remained ambulatory, alert, and appropriate for RCFE level of care with home health support. There is insufficient evidence to establish that the facility retained a resident beyond its licensed capacity. Based on records reviewed, the allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged did or did not occur.

Regarding the allegation staff did not administer medications as prescribed. The complaint alleged medication errors; however, available records do not contain documentation of missed or incorrect medication administration. No corroborating evidence was provided to show Resident 1’s prescribed medications were not administered properly. Based on records reviewed, the allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged did or did not occur.

No deficiencies cited Per title 22 regulations. An exit interview was conducted with facility Administrator Wesley Lavender. A copy of this report along with appeal rights were provided.

SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2025

LIC9099 (FAS) - (06/04)

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