Facility Evaluation Report

Licensing Program Analyst (LPA) Erica Mosley conducted an unannounced Case Management visit for the purpose of conducting a full physical plant tour along with reviewing the Stipulation and Waiver; Order adopted by the Department on 09/18/2025. The LPA met with Karen Pasten, Director of Resident Care (DRC) and explained the reason for the visit.

The LPA, alongside Karen Pasten, reviewed and discussed the contents of the Stipulation and Waiver; and Order adopted by the Department on 09/18/2025: 2. REVOCATION: STAYED WITH PROBATION: Respondents, Belmont Village Sabre Springs and Belmont Village Thousand Oaks licenses are revoked upon the Department's adoption of this Stipulation as its Order. The revocation of the licenses shall be STAYED for eighteen months during which time Respondents shall be granted probationary licenses subject to the following limitations and conditions: TERMS OF LICENSE PROBATION: 09/18/2025 - 03/18/2027

A. Respondents shall operate the facility in substantial compliance with the regulations and statutes governing the operation of a Residential Care Facilities for the Elderly (RCFE).

B. Respondents shall develop and implement the following policies, procedures, and training that Respondents stipulate will be incorporated into Respondents' Plans of Operation. Maintain accurate Medication Administration Records (MARs) for each resident: Include facility-administered and self-administered prescribed and PRN medications. Document medication name, dosage, dates, times, administering staff, missed doses, refusals, and offsite status. Record side effects, errors, and drug reactions on the back of MAR or in nurses' notes. Verify staff training and certification prior to medication administration. Conduct resident evaluations every six months or upon significant change in condition.