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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850158
Report Date: 09/11/2024
Date Signed: 09/12/2024 09:32:30 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
09/09/2024 and conducted by Evaluator Valeria Conway
COMPLAINT CONTROL NUMBER: 29-AS-20240909154531
FACILITY NAME:AASTA ASSISTED LIVINGFACILITY NUMBER:
565850158
ADMINISTRATOR:REYES, MONICAFACILITY TYPE:
740
ADDRESS:903 CARMEN DRIVETELEPHONE:
(805) 586-4191
CITY:CAMARILLOSTATE: CAZIP CODE:
93010
CAPACITY:130CENSUS: 77DATE:
09/11/2024
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Monica ReyesTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff prohibiting resident from leaving the facility for visits
Facility restricted visitation
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Valeria Conway and Kelly Dulek conducted an unannounced 10-day visit complaint o the facility regarding the above noted allegations. LPAs met with Administrator Monica Reyes and explained the reason for the visit.

During today's inspection, between 11:00 a.m. and 2:00 p.m., the LPA briefly toured the facility with the administrator, interviewed the Administrator, residents, caregivers and ombudsman. Additionally, LPAs conducted a file review, and obtained copies of pertinent documents relevant to the investigation.

It was alleged that the staff prohibited resident from leaving the facility for visits of their choosing, it is the concern of the reporting party that Resident #1’s (R1’s) personal rights are being violated. Interview with R1 revealed Administrator told R1 that R1 couldn’t leave the facility. Staff interviews revealed that Administrator stated that R1 can only leave the community with one specific family member.
Continued on LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2024
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 3
Control Number 29-AS-20240909154531
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: AASTA ASSISTED LIVING
FACILITY NUMBER: 565850158
VISIT DATE: 09/11/2024
NARRATIVE
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Continued LIC 9099

It was alleged that the facility restricted visitation by not allowing R1’s visitor to enter the facility. Reporting party indicated that R1’s visitor arrived at the facility and facility staff did not allow the visitor entry, both during visiting hours and after hours. It is the concern of the reporting party that facility’s visitation hours are very strict and not flexible. Based on interview and record review it was observed that facility has a “verbal” visiting hours of 8:30 a.m. to 5:00 p.m. Admission agreement does not show what are visitation hours for the facility nor is the facility’s visitation policy posted. Staff interviews conducted revealed that on 09/03/2024, there was a conversation between Administrator and staff where Administrator told employees not to allow R1 to have visitors after hours. Administrator stated that after hours visitations must be approved prior to loved ones coming to visit any residents. Staff interview revealed that a resident can allow entry to a visitor after hours. On 09/09/2024 R1 had an after hours visitor, however facility staff did not inform R1 of the visitor’s arrival and staff did not allow entry until a third party intervened.

Based on the information obtained, the allegations are deemed Substantiated at this time. Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiency was cited (refer to LIC 9099-D). Exit interview conducted.

Exit interview. Copy of report and Appeal Rights issued at the time of the visit.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20240909154531
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: AASTA ASSISTED LIVING
FACILITY NUMBER: 565850158
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/11/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
09/25/2024
Section Cited
CCR
87468.1(a)(6)
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87468.1(a)(6)To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night... to protect residents, or barring windows against intruders, with permission from the Department. This requirement is not met as evidenced by:
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Administrator agrees to submit a statement of understanding on regulation 87468.1(a)(6) and get staff trained by a third party on personal rigths by POC due date.
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Based on interviews and record review, the Administrator did not comply with the section cited above when staff was told not to allow R1 to leave the community with one specific family member, which posed a potential personal rights risk to residents in care.
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Request Denied
Type B
09/25/2024
Section Cited
CCR
87468.2(a)(21)
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87468.2(a)(21)To consent to have their relatives and other individuals of their choosing visit during reasonable hours, privately, and without prior notice.
This requirement is not met as evidenced by:
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Administrator agrees to submit a statement of understanding on regulation 87468.2(a)(21) and post visitation hours around the facility's common areas. POC due date.
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Based on interviews and record review, the Administrator did not comply with the section cited above when staff did not allow visiitors during reasonalble hours, which posed a potential personal rights risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2024
LIC9099 (FAS) - (06/04)
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