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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850158
Report Date: 02/19/2025
Date Signed: 02/19/2025 03:15:05 PM

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
01/28/2025 and conducted by Evaluator Valeria Conway
COMPLAINT CONTROL NUMBER: 29-AS-20250128143532
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: 83DATE:
02/19/2025
UNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Monica ReyesTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff did not respond to residents’ calls for assistance in a timely manner
Staff did not treat residents with dignity and respect
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Valeria Conway and Kelly Dulek conducted a subsequent complaint visit to the facility above to deliver final findings of the complaint allegations. At 11:20 A.M., LPAs met with Executive Director (ED), Monica Reyes, and explained the purpose of the visit.

During initial visit, between 10:30 A.M. and 4:00 P.M., LPA interviewed ED, nine (9) random residents, one (1) family member and five (5) staff members about above allegations. The Reporting Party (RP) was anonymous therefore, the LPA was unable to obtain additional information regarding the allegations. Also, during the visit, LPA conducted a review of timecards and obtained copies of pertinent documents relevant to the investigation.

During today’s visit, the LPAs conducted a brief physical plant tour, to ensure there are no health and safety concerns and the facility is in compliance with Title 22 regulation.
Continued on LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025
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 6
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
01/28/2025 and conducted by Evaluator Valeria Conway
COMPLAINT CONTROL NUMBER: 29-AS-20250128143532

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: 83DATE:
02/19/2025
UNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Monica ReyesTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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2
3
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5
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9
Staff are engaging in behaviors that put the residents’ health and safety at risk
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Valeria Conway and Kelly Dulek conducted a subsequent complaint visit to the facility above to deliver final findings of the complaint allegations. At 11:20 A.M., LPAs met with Executive Director (ED), Monica Reyes, and explained the purpose of the visit.

During initial visit, between 10:30 A.M. and 4:00 P.M., LPA interviewed ED, nine (9) random residents, one (1) family member and five (5) staff members about above allegations. The Reporting Party (RP) was anonymous therefore, the LPA was unable to obtain additional information regarding the allegations. Also, during the visit, LPA conducted a review of timecards and obtained copies of pertinent documents relevant to the investigation.

During today’s visit, the LPAs conducted a brief physical plant tour, to ensure there are no health and safety concerns and the facility is in compliance with Title 22 regulation.
Continued on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 29-AS-20250128143532
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: 02/19/2025
NARRATIVE
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Continued on LIC 9099-C

Regarding allegation “Staff are engaging in behaviors that put the residents’ health and safety at risk” it has been reported that staff members have exhibited inappropriate conduct while on duty during the PM shift and nocturnal (NOC) shift. Interviews with the Executive Director (ED) revealed that management is not aware of staff playing loud music or leaving the floor unsupervised during the NOC shift. Staff interviews did not corroborate these allegations. Residents interviewed indicated that some residents occasionally hear loud noises during the PM and NOC shift; however, they were unsure whether the sounds were from staff, residents playing music or singing or televisions. During the investigation, the LPAs inspected the staff break room for any prohibited items but found no evidence to support the allegations. Based on the information obtained during the investigation the LPA does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation “Staff are engaging in behaviors that put the residents’ health and safety at risk” is deemed UNSUBSTANTIATED at this time.

Exit interview conducted, copy of this report and was provided.

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

DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 29-AS-20250128143532
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: 02/19/2025
NARRATIVE
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Continued from LIC 9099

Regarding allegation “Staff did not respond to residents’ call for assistance in a timely manner” it has been reported that during the night shift, residents pulling the emergency cord to request assistance from staff had to wait approximately one (1) hour before being attended to by a staff member. LPAs interviewed staff and residents related to the facility’s pull cord system and response time. The facility contains a pull cord system; each resident room has one cord in the bed area/living space of the room and a second pull cord in the resident bathroom. When a resident pulls the cord, a light illuminates outside the resident room and on a switch boards located at the front desk and in the dining room. Interviews with the ED revealed that staff members are trained to assist residents within ten (10) to fifteen (15) minutes after a call cord is pulled. The most recent in-service training for call light monitoring was conducted on 08/2024. Additionally, the ED stated that after a resident communicated concerns about long response times, a group chat message addressing call cord wait periods was sent to all staff via text on 12/16/2024. This message served as a reminder that is unacceptable for residents to wait longer than fifteen (15) minutes for assistance. Interviews with staff revealed that caregivers may become occupied when multiple residents pull the emergency cord simultaneously. In such cases, staff prioritize responses based on the urgency of each call, which may result in less urgent request experiencing longer wait times. However, staff members stated they make every effort to assist all residents within fifteen (15) of the initial call. Interviews with residents revealed that seven (7) out of nine (9) residents reported experiencing long wait times across all three shifts after pulling the call cord. Most residents stated that response times could sometimes take forty-five (45) minutes to an (1) hour. Additionally, some residents expressed concerns that having only two (2) caregivers on duty is not sufficient to meet the need of the entire assisted living unit. Based on information gathered during the course of the investigation, there is sufficient evidence to determine that “Staff did not respond to residents’ calls for assistance in a timely manner” is deemed SUBSTANTIATED at this time.

Continued on LIC 9099-C

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

DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 29-AS-20250128143532
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: 02/19/2025
NARRATIVE
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Continued from LIC 9099-C

Regarding allegation “Staff did not treat residents with dignity and respect” it has been reported that staff members have been yelling at residents, despite concerns being brought to management, issue has not been addressed. Interviews with the ED revealed that management is not aware of any instances of staff mistreating or disrespecting residents. The ED stated that no residents or visitors have reported such concerns to management. Staff interviews presented mixed responses – some staff members reported witnessing colleagues speaking loudly or rudely to residents, while others denied any instances of mistreatment or disrespect. Additionally, those who denied such behavior stated that they had not witnessed any abusive conduct toward residents in care. Interviews with residents and family members revealed concerns regarding staff conduct. Resident #1 (R1) reported being spoken to disrespectfully, with sarcasm and dismissiveness by a Staff #1 (S1). Resident #2 (R2) stated that they have occasionally been handled roughly during transfers by Staff #2 (S2). Resident #3 (R3) reported being criticized by a staff member regarding their weight by Staff #3 (S3). Furthermore, several residents expressed concerns that the new hires do not appear to be receiving proper training. Based on information gathered during the course of the investigation, there is sufficient evidence to determine that “Staff did not treat residents with dignity and respect” is deemed SUBSTANTIATED at this time.

Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 9099-D.) Administrator was informed that failure to correct the deficiencies may result in civil penalties.

Exit interview conducted, appeal rights discussed, and a copy of this report and appeal rights were provided.

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

DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 29-AS-20250128143532
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: 02/19/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/21/2025
Section Cited
CCR
87464(f)(1)
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87464(f)(1) 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:
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Executive Director (ED) agreed to conduct a staff in-service related to resident call lights. ED will provide proof of training to CCL before POC due date.
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Based on interview, the facility did not comply with the above cited section, as residents reported having to wait on average 45-60 minutes for staff assistance when residents use their call buttons, which poses an immediate health, safety, and personal rights risk to residents in care.
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Type A
02/21/2025
Section Cited
CCR
87468.1(a)(1)
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87468.1(a)(1) Personal Rights. Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by:
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Executive Director (ED) agreed to provide training to all staff on personal rights of all residents with a Community Care Licensing certified vendor and will provide proof of scheduled training to CCL by POC due date. Proof of complete training to be provided upon completion.
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Based on interviews, the licensee did not comply with the section cited above when residents were not treated with dignity, which posed a immediate 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: 02/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6