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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565802462
Report Date: 10/22/2024
Date Signed: 10/22/2024 05:32:05 PM

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
09/18/2024 and conducted by Evaluator Esther Cortez
COMPLAINT CONTROL NUMBER: 29-AS-20240918103350
FACILITY NAME:SAGE MOUNTAIN SENIOR LIVINGFACILITY NUMBER:
565802462
ADMINISTRATOR:BETSY MCCOYFACILITY TYPE:
740
ADDRESS:3499 GRANDE VISTA DRTELEPHONE:
(805) 375-0695
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91320
CAPACITY:145CENSUS: 99DATE:
10/22/2024
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Christian CastilloTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Facility is not providing quality meals
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Esther Cortez conducted an unannounced subsequent complaint visit for the above allegations. Upon arrival, the LPA met with the Executive Director (ED) Christian Castillo, and was explained the reason for the visit. Entrance interview conducted.

On 09/23/2024, between 02:10 p.m. and 5:15 p.m., the LPA interviewed the Executive Director, one (1) staff, five (5) residents, conducted a tour of the kitchen/dinning areas and obtained copies of resident records and other pertinent documents relevant to the investigation. During today's visit, the LPA conducted file review, interviewed one (1) staff, five (5) residents, and obtained pertinent documents relevant to the investigation.

Report will continue on 9099-C (2ND PAGE).
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024
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 3
Control Number 29-AS-20240918103350
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: 10/22/2024
NARRATIVE
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On the allegation " Facility is not providing quality meals "; it is the concern of the reporting party that the facility is not providing fresh meals, serves frozen vegetables, do not have a variety of meals, and serve pork two to three times a week. On 09/23/2024, the LPA observed the kitchen around 2:50 p.m. and observed the following vegetables on stock such broccoli, carrots, potatoes, zucchini, tomatoes, squash, bell peppers, and cucumbers. Staff interview with the dining director revealed that food is prepared based on the menu, pork is served once a week, and that the facility has an alternate menu that the residents can order from if they do not like the meals for that day. Residents were interviewed about the food quality on 09/23/24 and during today’s visit. Ten out of Ten residents stated that the food is fresh, there is variety, and they have no concerns regarding the quality of the food, with one resident stating the quality of the food is excellent. On 09/23/24, the LPA observed a resident eating meat loaf with brown gravy, with smashed potatoes and green beans for dinner at approximately 4:06 p.m. During today’s visit, at approximately 1:20 p.m. the LPA observed a Fajita bar served for lunch with chicken, shrimp and beef options and onions and bell peppers. Beginning at 4:45 p.m. the LPA observed residents eating either a soup, sandwich, or seafood newburg over biscuit with mixed vegetables during dinner. Based on the information gathered through interviews and observation, the allegation that the Facility is not providing quality meals is deemed Unsubstantiated at this time.

Exit interview conducted. Today's report was reviewed and emailed to the Executive Director.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3