565850158-8-30-2023-29-AS-KHEN-CVDVEZ-20230905162308

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565850158
Report Date: 08/30/2023
Date Signed: 08/30/2023 01:19:55 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
08/28/2023 and conducted by Evaluator Kelly Dulek

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20230828164902

FACILITY NAME:	AASTA ASSISTED LIVING		FACILITY NUMBER:	565850158
ADMINISTRATOR:	REYES, MONICA		FACILITY TYPE:	740
ADDRESS:	903 CARMEN DRIVE		TELEPHONE:	(805) 586-4191
CITY:	CAMARILLO	STATE: CA	ZIP CODE:	93010
CAPACITY:	130	CENSUS: 59	DATE:	08/30/2023
		UNANNOUNCED	TIME BEGAN:	09:52 AM
MET WITH:	Monica Reyes		TIME COMPLETED:	01:25 PM

ALLEGATION(S):

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Licensee does not ensure food of good quality is served to residents in care
Staff does not ensure dietary restrictions are followed for residents in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kelly Dulek initiated an initial complaint visit for the above listed allegations. LPA arrived at 09:52AM and met with Wellness Director Esmeralda Elizarraraz at 10:00AM. Administrator was contacted via telephone and arrived at the facility at 12:50PM. Entrance interview conducted.

During today's visit, LPA toured the facility with Wellness Director at 10:04AM, interviewed residents from 10:40AM to 11:18AM and at 11:24AM and 12:35PM, observed staff delivering lunch and observed lunch in the dining room at 11:22AM. LPA toured the kitchen and took photos of the food supply at 11:36AM Additionally, LPA interviewed staff from 11:33AM to 12:02PM. The following was then determined:

It was alleged that the facility does not ensure the food is of good quality and that residents' dietary restrictions are not followed. Interviews revealed that the menu is posted, the kitchen staff prepare the food REPORT 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: 08/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

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-20230828164902

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: 08/30/2023

NARRATIVE

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that is listed on the menu, following low sodium recipes. Most residents interviewed reported being happy with the food. Some residents indicated the food is bland, but LPA observed that salt and pepper are available on dining room tables. Staff interviewed indicated they do not add oil or butter to the fruit and only use a little oil when sautéing the vegetables when the recipe calls for sauteed vegetables. LPA observed in the kitchen a board indicating the residents' dietary restrictions and/or dietary preferences. Staff interviewed were aware of different residents' diets and their preferences. Staff interviewed indicated that food for Resident #1 (R1), who is referred to in the complaint allegations, is prepared separately when recipe calls for added oil or butter. For R1, the salmon is steamed and all vegetables for R1 are either boiled or steamed. LPA observed a variety of foods in the pantry, refrigerator, and freezer. Posted menu items were available at the facility and today's meal observed followed the posted menu. Fresh fruits and vegetables were observed. LPA observed diced fruit, which was alleged to be coated in oil or butter. LPA did not observe any coating on the fresh diced fruits; they appeared to contain only fruit and some of the fruit's own juices. Residents interviewed reported no concerns with oil or butter on the fruits served. Based on interview and observation, although the allegations may be valid, at this time there is insufficient evidence to support the allegations or that a violation occurred; therefore, the allegations that "Licensee does not ensure food of good quality is served to residents in care" and "Staff does not ensure dietary restrictions are followed for residents in care" are 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: 08/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

LIC9099 (FAS) - (06/04)

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