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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565802462
Report Date: 12/18/2025
Date Signed: 12/18/2025 03:38:02 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
12/17/2025 and conducted by Evaluator Esther Cortez
COMPLAINT CONTROL NUMBER: 29-AS-20251217153345
FACILITY NAME:SAGE MOUNTAIN SENIOR LIVINGFACILITY NUMBER:
565802462
ADMINISTRATOR:CHRISTIAN CASTILLOFACILITY TYPE:
740
ADDRESS:3499 GRANDE VISTA DRTELEPHONE:
(805) 375-0695
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91320
CAPACITY:145CENSUS: 103DATE:
12/18/2025
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Christian Castillo/Gina Taylor TIME COMPLETED:
03:40 PM
ALLEGATION(S):
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Facility staff did not notify authorized representatives of falls.
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. ED was unavailable during exit enterview and designated Director of Health and Wellness Gina Taylor to review and sign the report.

During today's inspection, between 10:00 a.m. and 2:30 p.m., the LPA interviewed the ED, two (2) staff, conducted one (1) phone interview with Individual #1 (I1) and attempted to conduct a phone interview with Individual #2 (I2) and one (1) staff, 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.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2025
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 3
Control Number 29-AS-20251217153345
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: 12/18/2025
NARRATIVE
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Regarding the allegation, “Facility staff did not notify authorized representatives of falls”; it is the concern of the Reporting Party (RP) that Resident 1 (R1) has had three falls in the facility with the last one being on November 12, 2025, and staff did not notify R1’s authorized representatives of all three falls. A review of R1’s Identification and Emergency Information (LIC601) signed and dated 09/19/2024 revealed that Individual #1 (I1) is listed as their responsible person and Individual #2 (I2) as their person(s) responsible for financial affairs, payments for care, legal guardian if any. A review of R1’s Family Communication Form also lists I1 as R1’s primary contact/emergency contact #1 and I2 as R1’S primary contact/emergency contact #2. Interview with the Executive Director Christian Castillo revealed that I1 would be the person that needs to be contacted to notify of falls and the MedTech (MT) would usually be the one to notify them. Interview with one randomly selected MT revealed that based on R1’s file on their electronic medical record system I1 would be the person they need to contact to notify if R1 sustained a fall as they are listed as their Power of Attorney (POA). However, Interview conducted with I1 revealed that they were never notified by the facility that R1 had sustained a fall, were notified by R1 after being at the hospital for 8 hours and denied being R1’s POA. They further revealed that I2 is four hours away from R1 compared to them being only an hour away and they had already previously discussed with staff after prior falls that they should be the one to be notified. Furthermore, a review of an Unusual Incident/Injury report (LIC624) submitted to Community Care Licensing (CCL) on 11/18/2025, revealed that on 11/13/2025 staff responded to a pendant call and observed R1 on the floor, R1 was transported to the hospital and I2 was contacted. LIC624 does not indicate if I1 was contacted at all, however I1 denies they were contacted. Record review revealed that the facility does not have any POA records for R1, however has I1 listed as their POA in their electronic medical record system. Interview with Director of Health and Wellness Gina Taylor revealed that R1 was admitted to the facility as independent and their own responsible person, however they did confirm that even in these circumstances residents have emergency contacts listed as to whom staff should be notified of incidents. Based on the information gathered there is sufficient evidence to support the allegation and that a violation occurred; therefore, the above allegation is deemed Substantiated at this time.

Pursuant to Title 22, California Code of Regulations, the following deficiency is cited (refer to LIC 9099-D).Exit interview conducted, appeal rights discussed, and a copy of this report issued.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20251217153345
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: 12/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/22/2025
Section Cited
CCR
87568.1(a)(8)
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(8) To have their representatives regularly informed by the licensee of activities related to care or services, including ongoing evaluations, as appropriate to their needs.
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Director of Health and Wellness agrees to update their electronic medical record system on who should be contacted first and will submit a plan of action on all of the details and when this will be done to LPA by 12/22/25
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Based interviews and record review, the licensee did not comply with the section cited above when they did not inform R1’s responsible party of a fall with injury, which posed a potential health, safety and personal rights risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3