565802462-6-30-2023-29-AS-DPEA-CTXUXZ-20230721155911

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565802462
Report Date: 06/30/2023
Date Signed: 06/30/2023 06:33:38 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/21/2021 and conducted by Evaluator Kasandra Lopez

COMPLAINT CONTROL NUMBER: 29-AS-20210721151329

FACILITY NAME:	SAGE MOUNTAIN SENIOR LIVING		FACILITY NUMBER:	565802462
ADMINISTRATOR:	MARTHA BERARD		FACILITY TYPE:	740
ADDRESS:	3499 GRANDE VISTA DR		TELEPHONE:	(805) 375-0695
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91320
CAPACITY:	145	CENSUS: 113	DATE:	06/30/2023
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Leticia Higares		TIME COMPLETED:	01:50 PM

ALLEGATION(S):

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Facility staff financially abused resident(s)

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) KaSandra Lopez conducted an unannounced complaint inspection to deliver the findings regarding the above allegation. The LPA met with Regional Nurse Leticia Higares at 9:55 AM and explained the reason for the inspection. The visit was concluded with Director of Nursing Ian Gadea.

Allegation: Facility staff financially abused resident(s)

The allegation alleges while Resident #1 (R1) resided at the facility a credit card was taken from R1’s wallet and used unauthorized at retail establishments. Information received also revealed there was a pending theft investigation with law enforcement pertaining to another resident in the facility later identified as Resident # 2 (R2).
Report continued on LIC9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra Lopez	TELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2023

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 29-AS-20210721151329

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: SAGE MOUNTAIN SENIOR LIVING	FACILITY NUMBER: 565802462
	VISIT DATE: 06/30/2023

NARRATIVE

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During a previous inspection on 07/22/2021, LPA Lopez met with interim Administrator Jacob Primeau, reviewed records and conducted interviews with R2 and one staff member. Mr. Primeau was the Administrator until former Administrator Martha Berard was replaced. Mr. Primeau stated they began working at the facility at the end of May 2021. He stated the former Administrator advised him of the alleged theft concerning R1 that had been brought to her attention by a family member of R1, but he had no knowledge of any other alleged thefts in the building. During the course of the investigation, the LPA obtained and reviewed Ventura County Sheriff’s reports for two alleged credit card thefts pertaining to R1 in April 2021 and for R2 in approximately October 2020. R1 no longer resides at the facility as of May 2021.

Information received alleged R1 had two fraudulent charges in person on 04/16/21 in Reseda and on 04/17/21 in Woodland Hills. Although information received revealed R1 was mostly non-verbal and wheelchair bound, there is insufficient evidence to support a staff member made these charges or participated in this theft.

Information received during the investigation also revealed R2 had some fraudulent charges on their credit card and law enforcement identified Individual #1 (I1) as a person of interest. The LPA reviewed the criminal record clearance data base and this individual is not currently finger print cleared or associated to any licensed facilities in our data base. The LPA also checked with facility personnel and this individual was never a permanent employee or temporary agency staff member who worked at their facility. The interview with R2 revealed they recalled a theft occurred when they first moved in with their credit card but it had been resolved. R2 also reported cash missing from the their room but facility records and staff interviews revealed the reported missing cash was located in the resident’s room.

Based on the information received there is insufficient evidence to support the allegation of 'Facility staff financially abused residents'. Therefore, the allegation is deemed unsubstantiated at this time.

Exit interview and report reviewed with Ian Gadea. A copy of the report and appeal rights were provided.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra Lopez	TELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2023

LIC9099 (FAS) - (06/04)

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