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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565802462
Report Date: 05/07/2024
Date Signed: 05/10/2024 10:05:04 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
07/21/2023 and conducted by Evaluator Sandra Urena
COMPLAINT CONTROL NUMBER: 29-AS-20230721163427
FACILITY NAME:SAGE MOUNTAIN SENIOR LIVINGFACILITY NUMBER:
565802462
ADMINISTRATOR:JANELLE LOPEZFACILITY TYPE:
740
ADDRESS:3499 GRANDE VISTA DRTELEPHONE:
(805) 375-0695
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91320
CAPACITY:145CENSUS: 99DATE:
05/07/2024
UNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Betsy Mc CoyTIME COMPLETED:
05:45 PM
ALLEGATION(S):
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Facility has inadequate food service.
Facility staff are not meeting resident's needs.
Facility does not provide adequate transportation services.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Sandra Urena and Esther Cortez conducted an unannounced subsequent complaint investigation regarding the allegations listed above. The LPAs arrived at the facility at 10:10 a.m., met with Betsy McCoy, Executive Director, and explained the reason for the visit.

On 07/25/2023, Licensing Program Analyst (LPA) KaSandra Lopez conducted an unannounced complaint inspection at the facility regarding the above allegation. The LPA met with Business Office Manager Jennifer Miller and explained the reason for the inspection. During today's inspection between 12:46 PM and 3:15 PM, the LPA conducted interviews with the, Ms. Miler, Ian Gadea Nursing Director, three residents, and three staff members. The LPA also conducted record review at 2:36 p.m.

Continues on LIC 9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2024
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 5
Control Number 29-AS-20230721163427
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: SAGE MOUNTAIN SENIOR LIVING
FACILITY NUMBER: 565802462
VISIT DATE: 05/07/2024
NARRATIVE
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Facility has inadequate food service.
On the allegation that the facility has inadequate food service; it is the concern of the reporting party that the servers don't wait on residents and when they do, they bring the wrong food. On 05/07/2024, LPA Urena observed lunch in the dining room at approximately 12:15 p.m. Residents were interviewed about the food service and food quality. Ten out of ten residents stated that the food is always good, large portions are served, and when they order room service, the service is on time, and order is correct. Food servers try to serve the meals promptly and are always courteous. Residents stated that food selection has improved because the facility hired recently a new chef.
Based on the information gathered through interviews and observation, the allegation that the facility has inadequate food service, is deemed Unsubstantiated at this time.
Facility staff are not meeting resident's needs.
On the allegation that staff are not meeting the resident’s needs; it is the concern of the resident that the facility has only one caregiver a day to give showers to residents, and a different caregiver every day. LPA Urena interviewed residents about their needs being met, and most of the residents stated that staff are helpful, they assist with showers/baths twice a week. The staff clean their rooms once a week and do their laundry once a week.

Based on the information gathered through interviews, the allegation that facility staff are not meeting residents’ needs, is deemed Unsubstantiated at this time.

Facility does not provide adequate transportation services: The reporting party’s concern is that the facility does not provide transportation. LPA Urena interviewed residents. Ten out of ten residents stated that the facility does provide transportation services. Residents notify the facility staff about an upcoming appointment, and the residents are dropped off at the appointment place, and if needed the resident may request a companion to go with them to the appointments. At this time the facility has a bus and a company car for the transportation services at this time.

Based on the information gathered through interviews, the allegation of inadequate transportation, is deemed Unsubstantiated at this time.

No citations were issued. Exit interview was conducted and a copy of the report was issued.

SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
07/21/2023 and conducted by Evaluator Sandra Urena
COMPLAINT CONTROL NUMBER: 29-AS-20230721163427

FACILITY NAME:SAGE MOUNTAIN SENIOR LIVINGFACILITY NUMBER:
565802462
ADMINISTRATOR:JANELLE LOPEZFACILITY TYPE:
740
ADDRESS:3499 GRANDE VISTA DRTELEPHONE:
(805) 375-0695
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91320
CAPACITY:145CENSUS: 99DATE:
05/07/2024
UNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Betsy Mc CoyTIME COMPLETED:
05:45 PM
ALLEGATION(S):
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Staff do not respond to call pendant in a timely manner.
Staff does not safeguard resident's personal belongings.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Sandra Urena and Esther Cortez conducted an unannounced subsequent complaint investigation regarding the allegations listed above. The LPAs arrived at the facility at 10:10 a.m., met with Betsy McCoy, Executive Director, and explained the reason for the visit.

On 07/25/2023, Licensing Program Analyst (LPA) KaSandra Lopez conducted an unannounced complaint inspection at the facility regarding the above allegation. The LPA met with Business Office Manager Jennifer Miller and explained the reason for the inspection. During today's inspection between 12:46 PM and 3:15 PM, the LPA conducted interviews with the, Ms. Miler, Ian Gadea Nursing Director, three residents, and three staff members. The LPA also conducted record review at 2:36 p.m.

Continues on LIC 9099A-C...
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 29-AS-20230721163427
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: SAGE MOUNTAIN SENIOR LIVING
FACILITY NUMBER: 565802462
VISIT DATE: 05/07/2024
NARRATIVE
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Staff do not respond to call pendant in a timely manner.
On the allegation that staff do not respond in a timely manner; it is the concern of the reporting party that staff have been taking up to three hours to respond to a pendant call, and the usual wait time is an hour. On 07/25/2023, LPA Lopez interviewed residents and the interviews revealed that staff may respond right away and other times it could take up to 45 minutes to an hour to respond to a pendent call request, but sometimes it may take 2-3 hours to respond, and wait times are longer on the weekend, response times in the mornings are bad and sometimes at night, too. On 05/07/2024, LPA Cortez observed a resident at the front desk requesting assistance with a device, then heard a staff say, “if they call a caregiver, it will take about an hour for the caregiver to respond’, consequently another staff present, helped the resident at the time of the request. On 05/07/2024, LPA Urena interviewed a staff member in regards to the response time for the calls. The staff stated that the goal response time is between 10 to 15 minutes, however if they are busy with another resident, other staff members may assist. When the LPA asked about longer wait times, the staff stated that sometimes the push button may not be fully operating and consequently the staff are not aware of the call button being pushed.
Based on the information gathered through interviews, and observation, the allegation that staff do not respond in a timely manner, is deemed Substantiated at this time.

Staff does not safeguard resident's personal belongings.
On the allegation that staff do not safeguard the resident’s belongings; it is the concern of the reporting party that the staff loses clothes or throws them out without informing the resident. On 05/07/2024, LPA Urena interviewed residents. Five (5) out of 10 residents stated that they don’t have an issue with their laundry or any issues with missing items; five (5) residents stated that clothing items have been lost when staff have washed their clothing. On 07/25/2023, LPA Lopez interviewed staff who stated that some residents have complained about missing laundry and one staff stated that they threw away a piece of clothing that became too soiled to be washed, they attempted to replace the item but was not the right size, consequently had to return the item and get another item. Based on the information received through interviews, the allegation that staff do not safeguard residents’ belongings, is deemed Substantiated at this time.

Pursuant to Title 22, California Code of Regulations (CCR), the following deficiency is cited (refer to LIC 9099-D).

Citations were issued. Exit interview was conducted and a copy of the report and Appeal Rights were issued.

SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20230721163427
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: SAGE MOUNTAIN SENIOR LIVING
FACILITY NUMBER: 565802462
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/31/2024
Section Cited
CCR
1569.153(c)(d)
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Theft and loss. (c) Documentation of lost property with a value of twenty-five dollars or more within 72 hours of the discovery of the loss or theft, (d) A written inventory is established … items brought into or removed shall be added to or deleted from the inventory. This requirement is not met as evidenced by:
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POC: The Executive Director has agreed to the following:
The ED has agreed to the following:
1. Have an in-service training with staff regarding the facility’s theft and loss policy. Submit training documentation to CCL by POC date.

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Based on interview, the licensee failed to make reasonable efforts to safeguard a resident’s property, as the facility lost clothing items, which poses a potential personal rights risk to residents in care.
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Type B
05/31/2024
Section Cited
CCR
87468.2(a)(4)
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Residents…have all of the following personal rights: To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers...and competency to meet their needs. This requirement is not met as evidenced by:

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POC: Executive Director agrees to re-evaluate care response system that is conducive to residents’ needs.
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Based on interviews conducted, the licensee did not comply with the above cited section, as the licensee did not ensure resident’s call buttons were responded to timely which posed a potential health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5