Sunrise of Thousand Oaks

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Erica Mosley arrived at the facility unannounced to conduct a post licensing visit and entered the facility at 10:00 a.m. LPA was greeted by front door receptionist and explained the reason for the visit. The LPA met with Executive Director (ED) Brian Larios and the reason for the visit was explained. Entrance interview conducted. LPA Mosley and the ED toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The facility is a four (4) story building that consists of a memory care unit, and an assisted living unit. There are fire sprinklers and fire doors throughout the facility. A physical plant tour was conducted inside and out. An approved fire clearance was received on 02/25/2026, clearing them for a capacity of 158, of which ten (10) may be bedridden, and 148 may be non-ambulatory. All rooms are approved for non-ambulatory and bedridden residents. An updated document of room numbers/locations of all bedridden residents shall be maintained and available for emergency responders upon request. Delayed egress is approved for the memory care unit. Age range 60 and over. Hospice care waiver approved for twenty five (25) residents. Interviews: Starting at approx. 10:30 a.m. and throughout the visit LPA conducted random brief interviews with eight (8) residents and six (6) staff. Resident interviews revealed that no concerns were noted at the time of the visit. Staff interviews revealed that staff are knowledgeable in their job description, resident rights, different forms of abuse, and reporting procedures. Report Continued on LIC 809C... (PAGE 2) REPORT CONTINUED FROM LIC 809... Common Areas: These included the beauty salon, activity room, fitness center, bistro, and dining areas in assisted living and memory care units. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. Fireplaces were properly screened. LPA observed designated storage / utility rooms with emergency food and water. The facility maintained a comfortable temperature. Smoke detector(s) and carbon monoxide detector were operational at the time of the visit. There are fire extinguishers throughout the facility that were fully charged and were last serviced 05/11/26. The LPA observed required postings throughout the common space. The LPA observed the stairwells, and they each had an emergency evacuation chair at the fourth floor. Activity Rooms were observed and clean at the time of visit. LPA observed laundry rooms on all floors. Bedrooms: Starting at 10:30 a.m. The LPA and ED observed fifteen (15) randomly selected resident bedrooms, of which three (3) were on each floor, thus three (3) were in memory care and twelve (12) were in assisted living. All resident bedrooms were properly furnished with at least one chair, nightstand, and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. All passageways were observed to be clear of obstructions. Restrooms: The resident restrooms appeared clean and sanitary and in operating condition with grab bars and slip-resistant surfaces. The bathrooms were sufficiently stocked with supplies and paper towels; towels and washcloths are not shared in the private rooms. The hot water measured between 106.5 – 112.9 degrees Fahrenheit all within the required range. Surrounding Grounds (Outdoors): The LPA observed appropriate outdoor furniture, with a covered shaded area for residents in both, the memory care unit courtyard and the assisted living courtyard. Parking is available for residents and visitors. Kitchen: The LPA inspected the kitchen/food service area. Knives are stored and inaccessible to residents. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. Report continued on LIC809-C PAGE 3... (PAGE 3) REPORT CONTINUED FROM LIC 809-C PAGE 2... Records: Resident Records and Personnel records were reviewed starting at approx. 12:35 p.m., Six (6) personnel files were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. During the review LPA discovered that three (3) of the six (6) staff were not associated to the facility posing an immediate health and safety right risk to residents in care. At the time of the visit the Business Office Director began associating the staff to the facility. During file review LPA discovered an additional seven (7) staff not associated to the facility which poses an immediate health, safety and personal rights risk to persons in care. Six (6) resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan. All files in order at the time of the visit. Medication Audit: LPA conducted a medication review at approx. 2:25 p.m., LPA reviewed six (6) randomly selected resident centrally stored medication destruction record (CSMDR). The medications are centrally stored in the wellness room located on the third floor. Medications are labeled and checked for expiration dates. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. No errors observed during review. Documents: Documents obtained during the visit include: Facility roster, Resident roster and emailed copy of the Limited Liability insurance. At the time if the visit the LPA reviewed the facilities contact information on file including phone numbers, email and annual fees. ED updated the email on and confirmed that all information is accurate. Pursuant to Title 22, CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). A civil penalty in the amount of $5,000 was issued. Ten (10) staff were not associated to the facility, and each staff member had been working for more than five (5) days. The penalty was assessed at $500 per staff member, totaling $5,000 (10 x $500 = $5,000). ED was informed that failure to correct deficiencies may result in additional civil penalties. Exit interview conducted, report issued, and appeal rights provided.the state’s words, verbatim · CDSS document, Aug 10, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(3) · Plan of correction due date: Aug 11, 2026

(e) All individuals subject to a criminal record ... 1569.17(b) shall prior to working, ... in a licensed facility: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or This requirement is not met as evidenced by: Based on observation and record review, the licensee did not comply with the section cited above as ten (10) staff were not associated to the facility at the time of the visit which poses an immediate health, safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 10, 2026

Plan of correction: At the time of the visit, the Business Office Director began associating the staff to the facility. The Executive Director will submit a letter confirming that all staff have been associated and will ensure that, moving forward, all staff are fully associated to the facility prior to the start of employment.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Erica Mosley conducted a pre-licensing visit to the above-mentioned facility at 10 AM. LPA met with Belmont Village Executive Director (ED), Mark Ranno, and Belmont Village Director of Resident Care Services, Karen Pasten, along with the applicant / Executive Director (ED) / Regional Director of Operations Jason Malone. This application is for a Change of Ownership Application (CHOW) currently operating with Facility license # 565802433 and the current licensed facility has residents in care. The facility is a four (4) story building that consists of a memory care unit, and an assisted living unit. There are fire sprinklers and fire doors throughout the facility. A physical plant tour was conducted inside and out. An approved fire clearance was received on 02/25/2026, clearing them for a capacity of 158, of which ten (10) may be bedridden, and 148 may be non-ambulatory. All rooms are approved for non-ambulatory and bedridden residents. An updated document of room numbers/locations of all bedridden residents shall be maintained and available to emergency responders upon request. Delayed egress is approved for the memory care unit. Age range 60 and over. Hospice care waiver submitted and is pending approval. Common Areas: The facility maintained a comfortable temperature. Smoke detector(s) and carbon monoxide detector were operational at the time of the visit. There are fire extinguishers throughout the facility that were fully charged and were last serviced 04/04/2025. The LPA observed required postings throughout the common space. The LPA observed the stairwells, and they each had an emergency evacuation chair at the fourth floor. Activity Rooms were observed and clean at the time of visit. Fireplaces were observed adequately screened. LPA observed laundry rooms on all floors. Report Continued on LIC 809C... (PAGE 2) Report Continued from LIC 809... Bedrooms: The LPA observed fifteen (15) randomly selected resident bedrooms, of which five (5) were in memory care and ten (10) in assisted living. All resident rooms are set up with beds, nightstands, lamps, chests of drawers, chairs and closet space. The beds are furnished with box springs, comfortable mattress and clean linen; which includes, a mattress pad, top and bottom linens, pillowcases, blanket (if needed) and a bedspread. All rooms had a comfortable room temperature of 75 degrees Fahrenheit. Hot water temperature was measured in all fifteen (15) bathrooms and they were between the temperature range of 105-120 degrees Fahrenheit. Lighting in the rooms appeared adequate. In addition, no bedroom was used as a passageway to another room, bath or toilet. There is a brake room for staff at the facility. For nocturnal (NOC) shift, there will be awake night staff only. All rooms were free of odors. All window screens were clean and maintained in good repair. The resident bathroom(s) have a shower with non-skid materials. The toilets were in working conditions and the showers have grab bars. Surrounding Grounds (Outdoors): The LPA observed appropriate outdoor furniture, with a covered shaded area for residents in both, the memory care unit courtyard and the assisted living courtyard. Parking is available for residents and visitors. LPA observed facility generator to function properly at the time of the visit. Kitchen: The LPA inspected the kitchen/food service area the kitchen was observed to be inaccessible to residents in care. Knives are kept inaccessible to residents in care. Kitchen appliances were observed to be in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Dining room furniture was observed to be in good condition and appeared to be relatively clean. The supply of dishes, utensils, pots, pans and drink ware is adequate. Refrigerator and food pantry were checked for proper labels and expiration dates. The freezer was maintained at zero degrees Fahrenheit (0*F) and the refrigerator was maintained at 40*F. There are no pesticides (poisons) or toxins stored in any food storage area or preparation area with utensils. Trash cans had tight fitting lids. No flies or other vermin were observed. The LPA observed an adequate supply of emergency food and water. Report Continued on LIC 809C PAGE 3... (PAGE 3) Report Continued from LIC 809-C PAGE 2... Medications: The medications are centrally stored in the wellness room located on the third floor along with a medication cart on the second floor for the memory care unit which remains locked at all times. First aid supplies were complete along with a current version of a first aid manual. Resident and staff files will remain in Administrators offices, locked. Component III was conducted in conjunction with the visit. No corrections required on the pre-licensing visit at this time. Exit interview conducted. Report review and provided electronically. This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license.the state’s words, verbatim · CDSS document, Mar 25, 2026