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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565802462
Report Date: 05/19/2025
Date Signed: 05/19/2025 01:53:30 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
05/16/2025 and conducted by Evaluator Esther Cortez
COMPLAINT CONTROL NUMBER: 29-AS-20250516122438
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: 107DATE:
05/19/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Christian CastilloTIME COMPLETED:
01:55 PM
ALLEGATION(S):
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Staff did not prevent resident from harming other residents in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Esther Cortez conducted an unannounced initial 10-day complaint visit for the above allegation. Upon arrival, LPA met with the Executive Director (ED), Christian Castillo and explained the reason for the visit. Entrance interview conducted.

During today's inspection, between 09:00 a.m. and 1:30 p.m., the LPA interviewed the ED, five (5) staff, two (2) residents, conducted a file review, and obtained copies of resident records and other pertinent documents relevant to the investigation.

Report will continue on LIC9099-C, 2ND PAGE.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2025
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 2
Control Number 29-AS-20250516122438
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: 05/19/2025
NARRATIVE
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On the allegation, "Staff did not prevent resident from harming other residents in care" it was reported that three memory care residents were in a common hallway when Resident 1 (R1) became upset and lunged at Resident 2 (R2) causing them to fall and then R1 punched Resident 3 (R3). On 05/15/25 Administrator Christian Castillo called LPA Cortez to notified them of the incident and left a voicemail. On 05/16/25, LPA Cortez interviewed Administrator Castillo telephonically regarding the incident. Administrator Castillo informed the LPA that R1 had no history of aggression at the facility, there was staff present when the incident occurred, and law enforcement, resident's family member's and other appropriate agencies were notified. The Administrator further stated that they are working with the residents to ensure their safety, and provided R1 a 1:1 for the first 12 hours after the incident as a precaution. Per R1's Physician's Report dated 06/28/24, R1 had listed diagnosis of Mild Cognitive Impairment and Benign Prostatic Hyperplasia. The report indicated R1 did not have any inappropriate or aggressive behaviors, is able to follow instructions as well as communicate needs. Communities internal charting notes revealed that R1 had exhibited aggression towards R3 on one other occasion, however staff was present and intervened. Staff interviews revealed that even though R1 has exhibited agitation and verbal aggressive behavior, they had not observed R1 be physically aggressive towards another resident prior to this incident. When residents are exhibiting aggression staff will re-direct, attempt to see if activities will help the resident, monitor them, report it to their family and physician and suggest a medication evaluation. Staff interviews also revealed that staff was present when the incident occurred, the residents were in the staff's line of sight, staff does not believe anything could have prevented the incident as R1 did not show any alarming behavior prior to the incident, staff intervened as soon as they could and re-directed R1. Furthermore, staff interviews revealed that the community has addressed R1's agitation and aggressive behaviors with family and physician. R1 was interviewed and does not recall pushing or punching anyone. R1 revealed that they do not know who R2 is and that their relationship with R3 is good. R2 declined to be interviewed and R3 was not available for an interview. During today's visit the LPA observed R1 and R2 interacting amicably. Based on the information obtained, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2