565802462-11-26-2024-29-AS-KLOZ-DCJ7QZ-20250101205245

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565802462
Report Date: 11/26/2024
Date Signed: 11/26/2024 04:36:00 PM

Substantiated

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
09/12/2023 and conducted by Evaluator Esther Cortez

COMPLAINT CONTROL NUMBER: 29-AS-20230912151611

FACILITY NAME:	SAGE MOUNTAIN SENIOR LIVING		FACILITY NUMBER:	565802462
ADMINISTRATOR:	JANELLE LOPEZ		FACILITY TYPE:	740
ADDRESS:	3499 GRANDE VISTA DR		TELEPHONE:	(805) 375-0695
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91320
CAPACITY:	145	CENSUS: 94	DATE:	11/26/2024
		UNANNOUNCED	TIME BEGAN:	12:35 PM
MET WITH:	Christian Castillo-ED		TIME COMPLETED:	04:35 PM

ALLEGATION(S):

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Staff does not respond to resident's call button in a timely manner.

INVESTIGATION FINDINGS:

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At 12:35 p.m. Licensing Program Analyst (LPA) Esther Cortez conducted an unannounced subsequent complaint visit at the facility regarding the above allegation. The LPA met with Executive Director Christian Castillo and explained the reason for the visit.

On 09/18/2023, LPA Elsie Campos conducted interviews with witness at 10:45 a.m., Executive Director at 11:10 a.m. and collected and reviewed pertinent records begining at 12:20 p.m. On 11/25/2024, starting at 11:00 a.m. LPA Cortez conducted a file review and conducted four (4) staff and one (1) phone interview with Phillips Lifeline Technical Support. During today's visit starting at 1:00 p.m. the LPA conducted three (3) resident and two (2) staff interviews. Report will continue on LIC9099-C, 2nd page.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther Cortez	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 11/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024

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-20230912151611

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: 11/26/2024

NARRATIVE

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On the allegation " Staff does not respond to resident's call button in a timely manner"; it is the concern of the reporting party that residents experienced long wait times and on 09/11/23, Resident #1’s (R1’s) caregiver called out and they had no one to assist them for one and a half hours to get out of bed and dressed. It was further reported that R1 was up at 7:00 a.m. and called and no one came until 8:30 a.m. To investigate the allegation the LPA conducted a file review and interviews. A report of residents Personal Help Buttons (PHB) calls made between 09/10/2023 starting at 12:59:00 a.m. and ending on 09/11/23, 11:18:00 p.m. revealed that on 09/11/2023, R1 had a registered pendant call at 7:21:28 a.m. Per the report, R1 has two (2) different noted times for how long it took for the resident’s call to be answered; one being 29 minutes with 55 seconds and the second being 30 minutes and 9 seconds. The report also noted two reset times: 5 minutes with 45 seconds (which is how long it took the staff to reach the resident after claiming the call) and the second noted time being 35 minutes with 54 seconds (which is the total time from when the resident pressed their pendant to when the staff contacted the resident). Staff revealed that the “answer” times is how long it took the staff to claim the pendant call on their iPad, the reset time is when the resident is reached and the staff can reset the call, and the complete time is when the staff goes back and presses complete button on their iPad and would be the overall time it took the staff to complete the call. LPA Cortez conducted a phone interview with the Technical Support team from Phillips Lifeline, whose pendant system was used in the community in 2023. Tech Support revealed that whenever there is two different times reflecting under the “Answer” time, the bottom time is ultimately the time it took for staff to claim a call. Based on the information gathered, on 9/11/2023, at 7:21:28 a.m. it took staff 35 minutes and 54 seconds to reach R1 to assist them with their call. In addition, R1 had to wait to be assisted for over 15 minutes when pressing their pendant call in eight (8) out of nineteen (19) pendant calls made between 09/10/2023 starting at 12:59:00 a.m. and ending on 09/11/23, 11:18:00 p.m., with the highest wait time being 43 minutes and 34 seconds. Furthermore, the average reset time for residents noted on the report was 38 minutes and 12 seconds.

Based on the information gathered through file review, the allegation Staff does not respond to resident's call button in a timely manner is deemed Substantiated at this time.

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

Exit interview conducted, appeal rights discussed, and a copy of this report issued.

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther Cortez	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 11/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 29-AS-20230912151611

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: 11/26/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 12/10/2023 Section Cited CCR 87468.2(a)(4)	1 2 3 4 5 6 7	87468.2(a)(4)residents…shall 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, qualifications, and competency to meet their needs.This requirement is not met as evidence by:	1 2 3 4 5 6 7	ED agreed to have an in service with all staff regarding how to respond resident calls in a timely manner. Will submit proof of inservice to CCL by 12/10/23
	8 9 10 11 12 13 14	Based on records review, the licensee did not comply with the section cited above as Staff did not respond to R1’s call for assistance in a timely manner, which posed a potential health and safety risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther Cortez	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 11/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024

LIC9099 (FAS) - (06/04)

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