565850158-7-7-2023-29-AS-DPEA-CU2SWV-20230724141455

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565850158
Report Date: 07/07/2023
Date Signed: 07/07/2023 05:41:50 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
05/02/2022 and conducted by Evaluator Kelly Dulek

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20220502122736

FACILITY NAME:	AASTA ASSISTED LIVING		FACILITY NUMBER:	565850158
ADMINISTRATOR:	GUTIERREZ, ROBERT		FACILITY TYPE:	740
ADDRESS:	903 CARMEN DRIVE		TELEPHONE:	(805) 586-4191
CITY:	CAMARILLO	STATE: CA	ZIP CODE:	93010
CAPACITY:	130	CENSUS: 63	DATE:	07/07/2023
		UNANNOUNCED	TIME BEGAN:	02:31 PM
MET WITH:	Monica Reyes		TIME COMPLETED:	05:55 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility no longer has control of the property

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a subsequent complaint inspection with the purpose of delivering findings for the above allegation. The LPA met with Administrator Monica Reyes. Entrance interview conducted.

During an initial complaint visit conducted on 05/05/2022, LPA toured the facility with Administrator Robert Gutierrez at 1:33 PM, conducted Administrator interview at 12:48PM, and LPA gathered copies of pertinent documents. During the course of the investigation, LPA reviewed pertinent documents and conducted telephone interviews with relevant parties. The following was then determined:

It was alleged that the licensee no longer had control of the property, as the lease agreement between the property owner and the licensee had a specification related to approval of a HUD loan, which was not
Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023

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-20220502122736

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: AASTA ASSISTED LIVING	FACILITY NUMBER: 565850158
	VISIT DATE: 07/07/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

secured as agreed upon in the initial lease. At the time of the complaint, the licensee had yet to submit the documents related to the HUD loan. However, an amendment to the lease was agreed upon between the licensee and the property owner, extending an additional 18 months to receive HUD approval. Interviews revealed that the HUD loan application was submitted shortly after the complaint was received and approval for the HUD loan was granted on 02/01/2023, which is within the timeline agreed upon in the lease amendment. Interviews revealed that at no time did the licensee lose control of property. Based on interview and record review, at this time there is insufficient evidence to support the allegation or that a violation occurred, therefore the allegation that “facility no longer has control of the property” is deemed UNSUBSTANTIATED at this time.

No citations issued. Exit interview conducted. A copy of the report was provided.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2