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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565802462
Report Date: 03/14/2025
Date Signed: 03/14/2025 04:44:47 PM

Document Has Been Signed on 03/14/2025 04:44 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
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 LIVINGFACILITY NUMBER:
565802462
ADMINISTRATOR/
DIRECTOR:
BETSY MCCOYFACILITY TYPE:
740
ADDRESS:3499 GRANDE VISTA DRTELEPHONE:
(805) 375-0695
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91320
CAPACITY: 145CENSUS: 96DATE:
03/14/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Christian Castillo TIME VISIT/
INSPECTION COMPLETED:
04:45 PM
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Licensing Program Analyst (LPA) Esther Cortez conducted a case management visit at the community regarding a self reported incident that occurred on 03/02/2025. The LPA met with Administrator Christian Castillo and explained the reason for the visit.

It was reported that on 03/02/2025, Resident 1 (R1) went down to the front desk and asked the Concierge to call the paramedics because they "took a bottle of pills a couple hours ago in their room." Concierge called 911 immediately then radio the Med tech/Wellness Assistant. Resident was observed until paramedics arrived. Paramedics assessed the resident and transported to the hospital for further evaluation. It was further reported that R1 was on med management, left the community on 2/18/25, returned on 02/27/25 and did not disclosed filing a prescription with outside pharmacy on 02/19/25.

During today's visit the LPA conducted an interview with the Administrator, one (1) staff, conducted a file review, started a medication audit, and obtained pertinent documents relevant to the investigation.

Further investigation will need to be conducted and LPA will return at a later date.

No citations issued during today's visit. Exit interview conducted. Report provided.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE: DATE: 03/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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