Belmont Village Cardiff

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Allegation investigated: Lack of supervision resulted in sexual abuse.

Licensing Program Analyst (LPA) Arian Golbakhsh conducted an unannounced visit for a complaint investigation and delivered findings regarding the above mentioned allegation. LPA was welcomed by, identified themselves to, and discussed the purpose of their visit to Director of Resident Care Services Catherine Dorrian. Executive Director Wes Lavender arrived later during the visit. On 04/22/2024, the Department received a complaint where it was alleged that a resident (identified as R1) had been sexually assaulted by another resident (identified as R2) at the facility about four to five years ago. The Department’s investigation consisted of unannounced facility visits, records review, and interviews with staff, residents, and outside sources. [Continued on LIC 9099-C] Unsubstantiatedthe state’s words, verbatim · CDSS document, Mar 4, 2026 · control 08-AS-20240422135104

Allegation investigated: Staff did not contact police in a timely manner Staff are not assessing residents for change in level of care Staff are not meeting residents needs Staff left resident in wheel chair for extended period of time Facility is charging residents for services not used Staff are not meeting residents showering needs

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced facility visit to deliver findings on a complaint investigation. LPA Hurt met with facility Executive Wes Lavendar, and explained the purpose of today’s visit. Regarding the allegation Staff did not contact police in a timely manner. The allegation was disclosed to family on 03/09/2022. Law enforcement was not contacted until 03/10/2022. Mandated reporting law requires immediate notification. Based on interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Substantiatedthe state’s words, verbatim · CDSS document, Feb 22, 2026 · control 08-AS-20220317121016

Allegation investigated: Licensee did not provide the services necessary to meet resident needs which resulted in serious injury Licensee did not arrange or assist medical care for resident Facility did not provide adequate lighting Licensee did not follow reporting requirements

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced facility visit to deliver findings on a complaint investigation. LPA Hurt met with facility Executive Director, Wes Lavendar, and explained the purpose of today’s visit. Regarding the allegation Licensee did not provide the services necessary to meet resident needs which resulted in serious injury. On 06/18/2021 at approximately 10:00 p.m., Resident 1 (R1) fell in their apartment during a facility-wide power outage. R1 reported being on the floor all night without staff assistance until discovered at approximately 7:00 a.m. the following morning. R1 was later admitted to the hospital and diagnosed with a spinal cord injury. Interviews with staff confirmed that R1 was not checked on throughout the night despite emergency procedures requiring staff to check resident welfare during power outages. Supervisory staff were not notified until contacted by the responsible party the next day. Based on documentation reviewed, intthe state’s words, verbatim · CDSS document, Feb 22, 2026 · control 08-AS-20210715114337

Allegation investigated: 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

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 allegedthe state’s words, verbatim · CDSS document, Sep 26, 2025 · control 08-AS-20220404094758

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Allegation investigated: Licensee did not follow infection control protocol for scabies outbreak Licensee did not treat for pests

Licensing Program Analyst (LPA) Iby Strong conducted an unannounced visit to initiate an investigation on the above-mentioned allegations. LPA identified herself and discussed the purpose of the visit with Director of Resident Care Services Elizabeth Smith. On January 25, 2024, Community Care Licensing (CCL) received a complaint alleging licensee did not follow infection control protocol for scabies outbreak, and licensee did not treat for pest. During the investigation, LPA Strong collected pertinent resident records as well as facility documentation and conducted interviews. According to allegation, the licensee did not follow infection control protocol resulting in multiple scabies outbreaks. According to staff interview, the facility has not had an outbreak of scabies since January of 2023. Records reviewed revealed that all residents associated to the January 2023 outbreak were treated for scabies by medical providers. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jan 30, 2024 · control 08-AS-20240125155452

Allegation investigated: Staff are not meeting residents hygiene needs Staff are not responding to residents call buttons in a timely manner

Licensing Program Analyst (LPA) Tiffany Holmes conducted an unannounced visit to close out the complaint investigation regarding the above-mentioned allegations. LPA identified herself and met with Ashley Marcellus Administrator, to discuss the purpose of the visit and elements of the complaint. It was alleged that staff are not meeting residents hygiene needs. The Department's investigation included interviews, and a review of pertinent records, Interviews revealed the staff are meeting the residents needs by responding to them when they need something and assisting the residents with daily needs. Interviews revealed that the staff have been busy but the work with the residents is still getting done. The interviews revealed that the level of care is based on the individual residents care plans and that is how they determine how much assistance a resident needs. There were no witness statements that confirmed staff are not meeting residents hygiene needs. Unsubstantiatedthe state’s words, verbatim · CDSS document, Oct 17, 2023 · control 08-AS-20210803164339

Allegation investigated: Neglect/lack of supervision resulted in resident sustaining injuries.

Licensing Program Analyst (LPA), Sabel Martinez, conducted an unannounced complaint investigation visit to deliver findings. The LPA introduced himself and disclosed the purpose of the visit to Director of Resident Care Services, Elizabeth Smith. Throughout the investigation, the Department secured pertinent records and conducted interviews with staff, resident, and outside sources. It was alleged neglect and lack of supervision resulted in resident sustaining injuries. It was reported to the Department Resident # 1 (R1) had a fall resulting in a forehead laceration and abrasion to the knee. The reporting source reported concerns as R1 had suffered approximately seven falls within a week. Review of records obtained from the facility revealed R1 had sustained approximately five falls between 4/18/23 through 4/25/23, when R1 was transported to the hospital with a laceration to the forehead. Electronic mail communication between the facility and R1’s daughter revealed the facility and dauthe state’s words, verbatim · CDSS document, Aug 29, 2023 · control 08-AS-20230602142424