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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850158
Report Date: 05/14/2025
Date Signed: 05/15/2025 09:21:46 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
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: 78DATE:
05/14/2025
UNANNOUNCEDTIME BEGAN:
09:06 AM
MET WITH:Monica ReyesTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff are not providing activities for residents in care
Staff did not safeguard resident's medications
Staff did not administer medication as prescribed
Insufficient staffing
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Valeria Conway conducted a subsequent unannounced complaint visit to
the facility above to deliver final findings of the complaint allegations. At 9:15 A.M., LPA met with Executive. Director (ED), Monica Reyes, and explained the purpose of the visit. The following was determined.

On 05/07/2025, during the initial investigation visit, 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-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2025
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 7
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: 05/14/2025
NARRATIVE
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Continued from LIC 9099

During today’s visit, the LPA briefly toured the facility with the administrator

On the allegations: “Staff are not providing activities for residents in care” The RP expressed concern that the lack of staff directly impacted the facility’s ability to offer scheduled activities to residents. Interviews conducted with the ED confirmed that the facility has been experienced staffing challenges. The ED explained that during staffing shortages front desk personnel assisted with resident activities as needed. Management acknowledged that, due to these staffing issues, the facility had been unable to consistently provide scheduled activities to residents in care until recently. Management further stated that as of Monday (05/05/2025) a caregiver has been formally assigned to lead activities while the facility continues to hire additional care giving staff. Caregivers interviewed corroborated this and also revealed that when the driver position became vacant, the Activities Director was temporarily reassigned to perform transportation duties, resulting in the cancellation of daily activities. Resident interviews supported these claims. Several residents stated that after the prior driver left, activities were minimal and often limited to sitting in front of the television doing stretching exercises, or informal singing led by residents. However, residents also expressed optimism, noting that as of Monday, the facility has resumed structured activities such as Bingo. Based on information gathered during the course of the investigation, there is sufficient evidence to determine that scheduled daily activities were not being provided by the facility. Therefore, the above allegation “Staff are not providing activities for residents in care” is deemed SUBSTANTIATED at this time.

As to the allegation of Staff did not administer medication as prescribed and Staff did not safeguard resident's medications It was alleged that, due to understaffing, staff negligence, and an excessive workload, Resident #1’s (R1’s) eyedrops were missing for a couple of days, and medication prescribed for osteoporosis was missing for a few weeks, leading to a lapse in medication administration. Interviews with the Licensee and the ED revealed that for residents who are unable to manage their own medications, the facility stores the medication in the Med-Room.

Continued on LIC 9099-C

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

DATE: 05/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 7
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: 05/14/2025
NARRATIVE
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Continued from LIC 9099-C

Medication Technicians (Med-Techs) are responsible for ensuring proper administration, storage and timely refills of medications. Both the Licensee and ED acknowledge that the medication management system, particularly with regard to the Med-Techs and in-room storage, requires significant improvement due to instances of careless errors made by staff. Interviews with the Reporting Party (RP) reveal concerns regarding insufficient staff and prescribed medications not being administered as prescribed. Per RP, R1 allegedly received their medication dosage later than scheduled, with a second dosage administered earlier than directed. On one occasion, R1 did not received their prescribed P.M. medication due to facility staffing shortages. During interviews, Med-Techs reported that assigning a single individual to manage all responsibilities, including preparing medication, administering them in a timely manner, and overseeing prescription refills, is not sufficient to ensure safe and effective medication management. An internal review, along with staff interviews, revealed occasional lapses in medication management within the facility. Specifically, it was found that medications were not consistently stored in the med-room, administered and proper documented. Additionally, staff express concerned regarding insufficient training, lack of consistent oversight by management, and inconsistencies across shifts. LPA reviewed and compared on-hand pill counts, Medication Administration Record (MAR) and Centrally Stored Medication and Destruction Record (CSMDR). Medication audit conducted revealed discrepancies where the pill counts within bubble packs did not match the records documented. These findings corroborate that the facility failed to appropriately safeguard residents’ medication. Morning Med-Tech on duty was unaware of these discrepancies, while evening Med-Techs reported uncertainty about how these errors occurred, stating that often there is a breakdown in communication, documentation and medication administration between shifts. Based on information gathered during the course of the investigation, there is sufficient evidence to determine that staff are not administering resident’s medication in a timely manner. Therefore, both allegations “Staff did not administer medication as prescribed and Staff did not safeguard resident's medications” are deemed SUBSTANTIATED at this time.

Continued on LIC 9099-C

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

DATE: 05/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 7
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: 05/14/2025
NARRATIVE
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Continued from LIC 9099-C

As to the allegation of Insufficient staffing, it was alleged that R1 did not received their prescribed P.M. medication and daily activities due to facility staffing shortages. It is the concern of the RP that due to ongoing staff shortages the facility is not providing adequate supervision and care to the residents. Interviews with the Licensee and the ED confirmed that the facility has experienced staffing challenges. However, both the Licensee and the ED stated that the facility maintains sufficient staffing levels to cover for employees who resign or call out due to illness using caregiver from a staff agency. Residents interviewed stated that staffing deficits have directly impacted the quality and timeliness of care provided to them. Specifically, concerns have been raised regarding delays in medication management, including missed or late medication administration, as well as extended wait times for resident assistance. Interviews with staff revealed ongoing concerns related to workload and staffing levels. Staff reported feeling overworked, stressed, and overwhelmed due to persistent staffing shortages. They indicated that they are frequently required to assume additional responsibilities and take on extra shifts. Staff reported that this level of understaffing has led to them rushing through tasks leading to careless errors related to medication administration, missing timelines, delays in assisting residents, and longer response times to resident call signals. To further investigate these concerns, LPA conducted a comparison of staff schedules, timecards, and personnel reports (LIC 500). The review confirmed that facility has occasionally employees calling out of their schedule resulting in other staff members being required to work double shifts. In certain instances, employees were asked to report to work on their scheduled days off to ensure adequate coverage. Additionally, the LPA observed staffing gaps during shifts, with only two (2) caregivers and one (1) Med-Tech on duty to provide care for all residents including the Meadows (Memory Care). Based on information gathered during the course of the investigation, there is sufficient evidence to determine that shortage of staff is causing medication issues and longer wait times. Therefore, the above allegation “insufficient staffing” 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.

Continued on LIC 9099-C

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

DATE: 05/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 7
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: 05/14/2025
NARRATIVE
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Continued from LIC 9099-C

A $250 immediate repeat civil penalty for the citation related to CCR 87411(a) is assessed today. Another $250 civil penalty is assessed for the citation related to CCR 87465(a)(4) for a repeat violation. The Administrator Monica Reyes was informed that additional civil penalties might be assessed based on health and safety code 1569.49(f).

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: 05/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 7
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: 05/14/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/16/2025
Section Cited
CCR
87465(a)(4)
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87465 (a)(4) Incidental Medical and Dental Care. (4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by:
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ED will work with Licensee to have 2 med techs each shift and a supervisor present in the Med-Room. Licensee and ED will submit a written plan to ensure that extra help will be provided to current Med-Techs. Send to LPA before POC due date.
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Based on record review and interviews, the licensee did not comply with the section cited above by not ensuring medications are giving on a regular basis to residents in care which poses a immediate health, safety and personal rights risk to residents in care.
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Type A
05/28/2025
Section Cited
CCR
87411(a)
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87411(a) Personnel Requirements General (a) Facility personnel shall at all times be sufficient in numbers... In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure...This requirement is not met as evidenced by…
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ED agreed to hire more caregivers. Once they are hired, ED will provide a new LIC 500. Additionally, a written statement of understanding reg 87411 (a), submit a plan of action and ensure staff are not taking lunch at the same time. Statement due date 5/16/25.
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Based on interviews and record review the Executive Director did not comply with the regulation above by not having sufficient support staff to perform essential duties for residents in care which poses a potential health, safety and 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: 05/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 7
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: 05/14/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/29/2025
Section Cited
CCR
87219(f)
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87219 Planned Activities (f) Planned Activities. In facilities licensed for fifty persons or more, one staff member shall have full-time responsibility to organize, and shall be given such staff assistance as… This requirement is not met as evidenced by…
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ED will hire a new driver and the activity director will go back to conduct scheduled activities. In the meanwhile, caregiver will continue daily activities.
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Based on interviews, the licensee did not comply with the section cited above as the facility temporarily reassigned the Activities Director to perform transportation duties, resulting in the cancellation of daily activities, which posed a potential 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: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2025
LIC9099 (FAS) - (06/04)
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