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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850158
Report Date: 05/07/2025
Date Signed: 05/07/2025 05:52:43 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
05/01/2025 and conducted by Evaluator Valeria Conway
COMPLAINT CONTROL NUMBER: 29-AS-20250501125233
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: 80DATE:
05/07/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Monica ReyesTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Facility did not provide written notice to the resident for rate increase
INVESTIGATION FINDINGS:
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At 10:00 A.M., Licensing Program Analysts (LPAs) Valeria Conway conducted an unannounced 10-day visit complaint visit to the facility regarding the above noted allegation. At 10:20 A.M. LPA met with Marketing Director, Ashley Kumar. At 11:00 A.M. Licensee, Mr. Kumar arrived at the facility and at 11:20 A.M., Administrator, Monica Reyes joined the visit. LPA explained the reason for the visit. Entrance interview conducted.
During today's inspection, between 10:30 A.M. and 2:45 P.M., the LPA briefly toured the facility with the administrator and the director, interviewed the Administrator, residents, and caregivers. Additionally, LPA conducted a medication audit, file review and obtained copies of pertinent documents relevant to the investigation.

Continued on LIC 9099
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025
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 4
Control Number 29-AS-20250501125233
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: 05/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/14/2025
Section Cited
HSC
1569.655
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1569.655 (a) If a licensee of a residential care facility for the elderly increases the rates of fees for residents...the licensee shall provide no less than 90 days' prior written notice...the amount of the increase...This requirement is not met as evidenced by:
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Administrator will rescind letter issue to RP and issue a new one with correct effective date and submit proof that the admission agreement section Fees has been updated to reflect 90 days instead of 60 days.
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Based on interviews and record review, the licensee did not comply with the section cited above when they issued a general rate increase with less than 60 days’ notice, 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: 05/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 29-AS-20250501125233
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: 05/07/2025
NARRATIVE
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Continued from LIC 9099

On the allegation: Facility did not provide written notice to the resident for rate increase. it was alleged the administrator mailed an invoice to Resident 1's (R1’s) Responsible Party (RP) on 04/15/25 with a 6.5% rent increase due by 05/01/25. RP is concerned that the facility only gave them a two (2) week notice when regulation states that the licensee shall provide no less than 90 days’ prior written notice to the residents or the residents’ representatives., LPA reviewed facility’s Admission Agreement. Per the admission agreement, under section VI. Fees, subsection E 3-Adjustments to Range of Rates (rate increase): Facility shall give sixty (60) days’ prior written notice to you of any change in the rates for levels of care for the apartment you have chosen. LPA was able to get a copy of the letter mailed to RP. The written invoice reviewed, dated 04/15/2025, includes the new increased rate and states monthly rate (annual increase applied) as of 05/01/2025. On 05/02/2025, director, contacted LPA via phone to inquire about the matter. During the conversation, the Director expressed uncertainty as to whether a 60-day written notice to residents or their responsible parties was required, adding that rate change information is included in the admission agreement signed upon entry. LPA requested the Administrator to be included in the phone conversation. Administrator joined the call and when asked, they acknowledged that a 60-day written notice should always be provided prior to any rate change. During today’s visit, LPA clarified that, pursuant to updated Health and Safety regulation effective January 2025, on and after January 1, 2025, a licensee must provide no less than 90 days written notice for rate increases. The written notice must include the amount of the increase, the reason or reasons for the increase, and a description of the additional costs, except for an increase in the rate due to a change in the level of care of the resident (PIN 24-08-ASC page 4-5). LPA requested a revised version of facility’s admission agreement under section VI-E-3 to reflect new changes. Based on information gathered during the course of the investigation, there is sufficient evidence to determine that “Facility did not provide written notice to the resident for rate increase” 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

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

DATE: 05/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025
LIC9099 (FAS) - (06/04)
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