565850158-7-7-2023-29-AS-DPEA-CUWQS2-20230821122448

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565850158
Report Date: 07/07/2023
Date Signed: 07/07/2023 05:56:27 PM

Substantiated

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
10/28/2022 and conducted by Evaluator Kelly Dulek

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20221028153640

FACILITY NAME:	AASTA ASSISTED LIVING		FACILITY NUMBER:	565850158
ADMINISTRATOR:	AGUINIGA, DAVID		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:	06:00 PM

ALLEGATION(S):

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Staff are not responding timely to residents’ alerts

INVESTIGATION FINDINGS:

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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 11/02/2022, LPA interviewed Facility Designee at 12:35PM, toured the facility, including kitchen and all food service areas with facility Designee at 12:50PM, took photos of relevant facility areas, and conducted a telephone call with Licensee at 01:50PM. LPA also gathered copies of pertinent documents. During a subsequent complaint visit conducted on 06/13/2023, LPA conducted interviews with staff between 12:52PM and 2:15PM, observed dinner service in the dining room, conducted resident interviews between 04:58PM and 05:45PM, and gathered copies of documents pertinent to the investigation. Throughout the course of the investigation, LPA interviewed additional residents and staff during unrelated facility visits, as well as reviewed documents. The following was then determined: Report Continued on LIC 9099-C

Substantiated

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)

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Control Number 29-AS-20221028153640

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

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It was alleged that facility staff are not responding timely to residents’ alerts. LPA interviewed staff and residents related to the call button system and wait times. The facility utilizes a system where residents have a pull cord in their rooms near their bed, as well as one in the resident’s restroom, which triggers a light on the outside of the resident’s door as well as a light in the main dining room and at the front desk. During the day, front desk staff call on the walkie talkie when the panel lights up to inform care staff to go assist the resident. During the night, when front desk staff are not present, the care staff are responsible for walking around and paying attention to the call light panel. Resident interviews revealed that depending on the time of day and how busy the staff are, the time elapsed from pulling the cord to a staff responding to their room can be anywhere from a few minutes to an hour, but most often it’s 15-20 minutes before the staff respond. One resident indicated the staff “take their sweet time” when responding to the call light. Staff interviews revealed that while the workload is usually manageable, at times, the residents have to wait some time for assistance during the busier times of the day. Therefore, based on interview, the allegation that “facility staff are not responding timely to residents’ alerts” is deemed SUBSTANTIATED at this time.

Pursuant to Title 22 of the California Code of Regulations Division 6, Chapter 8, the following deficiency was cited (refer to LIC 9099-D). Failure to correct the deficiencies may result in civil penalties.

Exit interview conducted. A copy of the report and appeal rights were 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)

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Control Number 29-AS-20221028153640

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/07/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/10/2023 Section Cited CCR 87464(f)(1)	1 2 3 4 5 6 7	87464 Basic Services (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Administrator agreed to conduct a staff inservice related to resident call lights on 07/11/2023. Administrator will provide proof of training to CCL upon completion of training.
	8 9 10 11 12 13 14	Based on interview, the facility did not comply with the above cited section, as residents reported having to wait on average 15-20 minutes for staff assistance when residents use their call buttons, which poses an immediate health, safety, and personal rights risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

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 appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 6

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
10/28/2022 and conducted by Evaluator Kelly Dulek

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20221028153640

FACILITY NAME:	AASTA ASSISTED LIVING		FACILITY NUMBER:	565850158
ADMINISTRATOR:	AGUINIGA, DAVID		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:	06:00 PM

ALLEGATION(S):

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Staff is unaware of emergency water supply
Staff are not posting food menus
Staff are not providing nutritious foods
Staff are not properly safeguarding the facility ground

INVESTIGATION FINDINGS:

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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: 4 of 6

Control Number 29-AS-20221028153640

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

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Allegation: Staff is unaware of emergency water supply:

During the initial complaint visit, LPA toured the facility and observed the facility’s emergency water supply. LPA took photos of the supply located in the kitchen pantry. Dining staff interviewed indicated they are aware of where to find the emergency supply and were able to articulate to the LPA where the water is located. LPA spoke with staff identified in the emergency disaster plan to oversee the emergency supply and those staff were also aware of the emergency supply location. Additionally, the facility has 2 automatic water dispensers located in the common areas of the facility. In the event of a power outage, the water dispensers will still function, and residents will continue to have available drinking water. Based on interview and observation, there is insufficient evidence to support the allegation or that a violation occurred, therefore, the allegation that “staff is unaware of emergency water supply” is deemed UNSUBSTANTIATED at this time.

Allegation: Staff are not posting food menus:

It was alleged that although menus were placed at each dining table, the weekly dining menu was not posted at the facility. LPA visited the facility multiple times throughout the investigation and took photos of the posted menu at each visit. Interview with Administrator revealed that menus are printed weekly and posted on Monday mornings. One Monday morning two weeks prior to the initial complaint visit, there had been a car accident near the facility, which caused a power outage at the facility. The facility’s emergency generators had kicked in to ensure continuity of care to the residents and food preparation was uninterrupted, but the weekly menu was unable to be printed prior to breakfast service. When Administrator arrived at the facility, the menu was printed and posted at that time. Daily menus were available on each dining table and the dining staff did have a printout of the weekly menu. Additionally, residents had previously received a copy of the weekly menu in their rooms. Interviews revealed that menus are posted and there have been no concerns with communicating to the residents the daily or weekly food choices. Based on interview and observation, there is insufficient evidence to support the allegation or that a violation occurred, therefore, the allegation that “staff are not posting food menus” is deemed UNSUBSTANTIATED at this time.

Allegation: Staff are not providing nutritious foods:

It was alleged that in the bistro area, there were no snacks available other than popcorn. LPA observed the Bistro 3 (three) times during the course of the investigation. At each visit, LPA observed fruit, sandwiches in the refrigerator, as well as snacks available in the Bistro. Interview revealed that the food in the Bistro is Report Continued on LIC 9099-C

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: 5 of 6

Control Number 29-AS-20221028153640

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

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restocked 4 (four) times a day by the kitchen staff. There are some residents who will take all the food left out in the Bistro, so that is being addressed. Residents interviewed indicated there are snacks available all day, such as sandwiches, various fresh fruits, Jello, and pudding. Residents stated they can get their own snack from the Bistro or they can ask the caregiver or med tech to bring them almost any food of their choosing at any time of the day. Based on interview and observation, at this time there is insufficient evidence to support the allegation or that a violation occurred, therefore, the allegation that “staff are not providing nutritious foods” is deemed UNSUBSTANTIATED at this time.

Allegation: Staff are not properly safeguarding the facility grounds:

It was alleged that doors to empty rooms were found unlocked, which could be a potential safety hazard to residents in care. Administrator interview revealed that there are rooms that were left unlocked for the purpose of staff offering facility tours during the weekend when Administrator was not present at the facility. The rooms are vacant and set up with furnishings such as a bed, dresser, and chair. During the initial complaint visit, LPA checked all doors during the facility tour and none were found to be unlocked. LPA asked Administrator to unlock vacant rooms for observation during the facility visits. LPA found no hazardous items in any of the vacant rooms that had been previously unlocked for the purpose of offering tours. Based on interview and observation, at this time there is insufficient evidence to support the allegation or that a violation occurred, therefore the allegation “staff are not properly safeguarding the facility grounds” is deemed UNSUBSTANTIATED at this time.

No citations issued for the allegations addressed above. 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)

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