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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565802462
Report Date: 12/27/2024
Date Signed: 12/27/2024 11:52:11 AM

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 Erica Mosley
COMPLAINT CONTROL NUMBER: 29-AS-20230912151611
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: 93DATE:
12/27/2024
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Executive Director, Christian Castillo TIME COMPLETED:
11:55 AM
ALLEGATION(S):
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8
9
Facility does not have adequate staffing to assist resident with care needs.
INVESTIGATION FINDINGS:
1
2
3
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5
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7
8
9
10
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13
At 10:30 a.m. Licensing Program Analyst (LPA) Erica Mosley conducted an unannounced subsequent complaint visit at the facility to deliver findings for the allegation listed above. 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 beginning at 12:20 p.m. On 11/25/2024, LPA Esther Cortez, starting at 11:00 a.m., conducted a file review and conducted four (4) staff and one (1) phone interview with Phillips Lifeline Technical Support.

Report continued on LIC9099-C....
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE:

DATE: 12/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2024
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-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: 12/27/2024
NARRATIVE
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Report continued from LIC9099...

On 11/26/2024, LPA Cortez, starting at 1:00 p.m., conducted four (4) resident and two (2) staff interviews. On 12/02/2024, LPA Cortez, starting between 11:40 a.m. and 4:30 p.m. the LPA conducted two (2) staff and five (5) resident interviews and obtained copies of resident records and other pertinent documents relevant to the investigation. 12/13/2024, LPA Cortez, between 01:00 p.m. and 4:15 p.m., the LPA interviewed two (2) staff, conducted a file review, and obtained copies of resident records and other pertinent documents relevant to the investigation. On 12/16/2024, LPA Cortez, between 10:30 a.m. and 4:30 p.m., conducted five (5) staff interviews and obtained copies of pertinent documents relevant to the investigation.

On the allegation "Facility does not have adequate staffing to assist resident with care needs"; it is the concern of the reporting party that there is not enough staff on shifts. It was further reported that on 09/11/2023, Resident 1 (R1) was up at 7:00 a.m., called, and had no one to assist them for one and a half hours to get out of bed and dressed until someone went at 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 a.m. and ending on 09/11/2023, 11:18 p.m. revealed that on 09/11/2023, R1 had a registered pendant call at 7:21 a.m. Per the report, it took staff 35 minutes and 54 seconds to reach R1 to assist them with their call. In addition, R1 had to wait for over 15 minutes when pressing their pendant call in eight (8) out of nineteen (19) pendant calls made between 09/10/2023 and 09/11/2023, with the highest wait time being 43 minutes and 34 seconds. Furthermore, the average wait time for the residents to be assisted noted on the report was 38 minutes and 12 seconds.

Interviews conducted with staff revealed that a full staffed morning shift is four (4) caregivers and (2) MedTechs (MT) in Assisted Living and three (3) caregivers and one (1) MT in Memory Care. Six (6) out of eight (8) staff that were working at the community during 2023, recall or have knowledge of the community being understaffed, including in September of 2023 during the time the complaint was submitted. A staff revealed that there has been plenty of times that there have only been two (2) staff on the floor, they further revealed that there was one shift where they were the only staff in all four (4) floors in Assisted Living.

Report continued on LIC9099-C....

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE:

DATE: 12/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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: 12/27/2024
NARRATIVE
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Report continued from LIC9099...

The staff also revealed that it was noticeable that there were times that R1 had peed on themselves because staff did not get to them on time due to there not being enough staff. Other staff revealed that residents brought up concerns of staff being understaffed in the town hall meetings many times. Many staff revealed that the community is currently doing a lot better this year and believe their workload is manageable, however their workload can become not manageable if staff calls out and management does not have anyone to cover their shift. Additionally, staff revealed that their workload was not manageable in 2023. Staff revealed they often had to take on other’s responsibilities due to lack of staff and felt stressed and rushed. Furthermore, staff revealed that they felt bad for the residents during that time, because they were not getting the good service that they deserve. Two residents revealed that in 2023, the community was understaffed, and it was noticeable as staff would be in a hurry to assist, there were times they had to wait as much as two (2) hours for assistance and one of the residents stated that there was an incident where they had to wait for their medication over three (3) hours. Based on the information gathered through interviews, although staff interviews revealed that staffing has improved, at the time the complaint was submitted the community did not have adequate staffing to assist resident with care needs, therefore the allegations is deemed Substantiated at this time.

Although allegation is Substantiated, a citation will be issued for this deficiency under complaint control #29-AS-20231030120440 for same allegation.



Exit interview conducted, appeal rights discussed, and a copy of this report issued.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE:

DATE: 12/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2024
LIC9099 (FAS) - (06/04)
Page: 3 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
09/12/2023 and conducted by Evaluator Erica Mosley
COMPLAINT CONTROL NUMBER: 29-AS-20230912151611

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: 93DATE:
12/27/2024
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Executive Director, Christian Castillo TIME COMPLETED:
11:55 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not assist resident with restroom needs resulting in resident developing multiple UTI's.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
At 10:30 a.m. Licensing Program Analyst (LPA) Erica Mosley conducted an unannounced subsequent complaint visit at the facility to deliver findings for the allegation listed above. 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 beginning at 12:20 p.m. On 11/25/2024, LPA Esther Cortez, starting at 11:00 a.m., conducted a file review and conducted four (4) staff and one (1) phone interview with Phillips Lifeline Technical Support.

Report continued on LIC9099-C....
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE:

DATE: 12/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
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: 12/27/2024
NARRATIVE
1
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3
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Report continued from LIC9099...

On 11/26/2024, LPA Cortez, starting at 1:00 p.m., conducted four (4) resident and two (2) staff interviews. On 12/02/2024, LPA Cortez, starting between 11:40 a.m. and 4:30 p.m. the LPA conducted two (2) staff and five (5) resident interviews and obtained copies of resident records and other pertinent documents relevant to the investigation. 12/13/2024, LPA Cortez, between 01:00 p.m. and 4:15 p.m., the LPA interviewed two (2) staff, conducted a file review, and obtained copies of resident records and other pertinent documents relevant to the investigation. On 12/16/2024, LPA Cortez, between 10:30 a.m. and 4:30 p.m., conducted five (5) staff interviews and obtained copies of pertinent documents relevant to the investigation.

On the allegation, “Staff did not assist resident with restroom needs resulting in resident developing multiple UTI's” it is the concern of the reporting party that Resident 1 (R1) had three (3) Urinary Tract Infections and believes that a slow call light response is a contributor. No additional information was provided regarding the resident’s UTI’s. Staff interviews revealed that residents are changed every two (2) hours, however many staff revealed that R1 frequently pressed their pendant and was checked on a lot more often. File review revealed that R1 was able to use the restroom with assistance and wore briefs. No specific dates or timeframes were provided regarding when UTIs were diagnosed. There are no medical records on file to confirm that the resident developed UTIs. Furthermore, there was no evidence indicating the source of R1’s UTIs. Based on the above information gathered although the allegation may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the allegation is deemed unsubstantiated at this time.

Exit interview conducted, copy of this report issued.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE:

DATE: 12/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5