Facility Evaluation Report, 06/10/2022 — Sage Mountain Senior Living, Thousand Oaks CA

Licensing Program Analyst (LPA) KaSandra Lopez conducted an unannounced Case Management - Incident inspection at the facility today to follow up on self reported reports received. The LPA met with Administrator Jill Ford at 10:31am and explained the reason for today's inspection.

The LPA met with the Administrator and Nicole Hozner, Director of Health and Wellness, in the Administrator's office. On 05/28/2022, Community Care Licensing Division (CCLD) received a faxed death report pertaining to Resident#1 (R1) who passed away on 05/28/2022. The LPA reviewed facility records and discussed R1's history with the Administrator and Ms. Hozner between 11:10 AM and approximately 2:00 PM. The LPA obtained copies of pertinent records and determined further investigation is needed.

At 2:03 PM, the LPA began record review for Resident #2 (R2). On 05/22/2022, the LPA received an email at 8:38pm notifying the LPA of a memory care resident elopement on 05/22/2022. The Administrator reported the resident was found unharmed by law enforcement and a written report with more details would follow. On 05/27/2022, CCLD received a faxed incident report pertaining to R2 who eloped from the facility on 05/22/2022 at approximately 12:30 AM. The report states due to a new agency caregiver, Staff #1 (S1), misunderstanding instructions given by a facility caregiver, S1 assumed it was acceptable to allow R2 leave the secured memory care unit. At approximately 12:15am, S1 inputted the door code and allowed R2 to exit the memory care unit and observed R2 get on the elevator. At approximately 12:30am, the main lobby entrance door triggered the alert system notifying staff a resident had exited the community. An internal and external facility search was conducted by staff. At approximately 12:45am, Staff #2 (S2) called 911 to report a missing resident. At approximately 12:50am, police contacted S2 to report R2 had been found at a nearby McDonald's on Wendy drive. A separate police report was made by a bystander which made R2's return back to the facility quicker. Police returned R2 back to the facility at approximately 1:00am. S2 assessed R2 upon there return and did not observe any injuries. Report continued on LIC 809-C.