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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 03:25:32 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
03/20/2024 and conducted by Evaluator Kelly Dulek
COMPLAINT CONTROL NUMBER: 29-AS-20240320110032
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:
11:17 AM
MET WITH:Monica ReyesTIME COMPLETED:
03:35 PM
ALLEGATION(S):
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Staff handled resident in a rough manner
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Valeria Conway and Kelly Dulek conducted a subsequent complaint investigation with the purpose of delivering findings for the allegation listed above. LPAs arrived at the facility at 11:17AM and met with Executive Director (ED) Monica Reyes. Entrance interview conducted.

During an initial complaint visit conducted on 03/21/2024, LPAs Dulek and Arroyo interviewed ED at 02:18PM, toured the facility at 02:20PM, and obtained current resident roster and staff schedule. During a subsequent complaint visit completed on 02/04/2025, LPAs Dulek and Conway interviewed ED at 10:45AM, toured the facility at 11:24AM, interviewed residents and staff from 12:17PM to 03:40PM and obtained current resident roster and staff schedule. Throughout the course of the investigation, LPA also conducted telephonic interviews with staff and other relevant parties. The following was then determined:

Report Continued on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
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 5
Control Number 29-AS-20240320110032
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: 02/19/2025
NARRATIVE
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It was alleged that Staff #1 (S1) is physically rough when working with Resident #1 (R1). Interview revealed that R1 preferred for S1 to provide their care and that R1 regularly asked for S1 to work with them. Staff interviewed indicated that R1 requested male caregivers often, particularly S1. LPA was unable to interview R1 related to this allegation. Staff interviewed indicated that they had never observed any staff handling R1 roughly. Other residents interviewed indicated that the care provided is adequate and they had never personally been handled roughly or were aware of other residents being handled roughly. The information obtained during the investigation did not include evidence sufficient to corroborate the allegation. Although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time.

No citations issued related to the above allegation. Exit interview conducted. A copy of today’s report was provided.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
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: 2 of 5
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
03/20/2024 and conducted by Evaluator Kelly Dulek
COMPLAINT CONTROL NUMBER: 29-AS-20240320110032

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:
11:17 AM
MET WITH:Monica ReyesTIME COMPLETED:
03:35 PM
ALLEGATION(S):
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Staff made inappropriate comments towards resident
Staff are not providing a safe and comfortable environment for resident
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Valeria Conway and Kelly Dulek conducted a subsequent complaint investigation with the purpose of delivering findings for the allegations listed above. LPAs arrived at the facility at 02:16PM and met with Executive Director (ED) Monica Reyes. Entrance interview conducted.

During an initial complaint visit conducted on 03/21/2024, LPAs Dulek and Arroyo interviewed ED at 02:18PM, toured the facility at 02:20PM, briefly interviewed Resident #1 (R1), and obtained current resident roster and staff schedule. During a subsequent complaint visit completed on 02/04/2025, LPAs Dulek and Conway interviewed ED at 10:45AM, toured the facility at 11:24AM, interviewed residents and staff from 12:17PM to 03:40PM and obtained current resident roster and staff schedule. Throughout the course of the investigation, LPA also conducted telephonic interviews with staff and other relevant parties. The following was then determined:

Report Continued on LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
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: 3 of 5
Control Number 29-AS-20240320110032
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: 02/19/2025
NARRATIVE
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The complaint alleges that staff make rude and disparaging comments about Resident #1 (R1) related to their mental health condition, which creates an uncomfortable and unsafe environment for R1. Although management denied the allegation, interviews with staff revealed that they have heard multiple other staff members comment and make fun of R1 behind their back. Additionally, LPA spoke with 2 (two) other witnesses not employed by the facility, both of whom indicated they had overheard certain staff talking and laughing about R1. While LPAs were only able to briefly discuss this particular complaint with R1 during the initial complaint visit, R1 did express to LPA at that time and in previous interviews that staff are rude to R1 and that staff made fun of R1 and their condition. R1’s physician’s report indicated R1 had a diagnosis of paranoid schizophrenia. As a result of R1’s diagnosis, R1 would “call for help constantly,” according to staff. R1 reported that staff would come to assist, but would be rude and short with them. At times, R1 indicated that staff would purposely put the pull cord out of reach of R1, who was bedbound, and R1 had to use their cell phone to call the front desk for assistance. Staff interviewed indicated there was no specific mental health training provided or training on how to address R1’s particular needs, and as a result staff were unaware of how to talk to R1 appropriately. Based on information gathered during the course of the investigation, there is sufficient evidence to support the allegations that “staff made inappropriate comments towards resident” and “staff are not providing a safe and comfortable environment for resident” are deemed SUBSTANTIATED at this time.

Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiency was cited (refer to 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: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
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 5
Control Number 29-AS-20240320110032
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: 02/19/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/07/2025
Section Cited
CCR
87468.1(a)(3)
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87468.1 Personal Rights of Residents in all Facilities (a) (3) to be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature...or elimination

This requirement is not met as evidenced by:
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Executive Director 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 completed training to be provided upon completion.
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Based on interview, the licensee did not comply with the above cited section, as multiple staff and witnesses reported staff being disrespectful and rude to R1 and making fun of R1, which posed an immediate personal rights risk to persons 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: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
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: 5 of 5