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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850158
Report Date: 05/29/2025
Date Signed: 05/29/2025 08:22:03 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
05/13/2025 and conducted by Evaluator Valeria Conway
COMPLAINT CONTROL NUMBER: 29-AS-20250513154404
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: 76DATE:
05/29/2025
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Monica ReyesTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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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, Kelly Dulek, Martha Arroyo and Licensing Program Manager (LPM) Kristin Heffernan, conducted a subsequent unannounced complaint visit to
the facility above to deliver final findings of the complaint allegations. At 10:30 A.M., LPA Conway met with Executive. Director (ED), Monica Reyes, and explained the purpose of the visit.

On 05/14/2025, between 9:30 A.M. and 1:30 P.M., the LPA briefly toured the facility with the
administrator. Also, LPA interviewed the Administrator and caregivers. Additionally, LPA
conducted a medication audit, file review and obtained copies of pertinent documents relevant to the
investigation. The following was determined.

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

DATE: 05/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2025
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 3
Control Number 29-AS-20250513154404
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: 05/29/2025
NARRATIVE
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Continued from LIC 9099

On the allegation: “Staff are engaging in behaviors that put the residents’ health and safety at risk" The RP expressed concern that three (3) caregivers and one (1) Med-Tech were observed consuming alcohol while on duty inside the staff lunchroom. LPA Conway conducted interviews with Reporting Parties (RP) as well as additional staff members who were not involved in the incident. All interviewed parties were able to identify the same three (3) caregivers and one (1) Med-Tech as those involved in the alleged misconduct.

The LPA also interviewed the facility ED, who confirmed that progressive disciplinary actions were issued to the three (3) caregivers and one (1) Med-Tech on 01/27/2025. The individuals who received disciplinary action were the same individuals identified by RP and other staff during interviews. Documentation provided by the ED confirms that these staff members violated AASTA's policy 8.6 (Drug and Alcohol Use) by being under the influence of alcohol while on duty and on AASTA's property.

Additionally, the LPA obtained video evidence clearly showing all staff members involved in the incident consuming alcoholic beverages, with visible cans present during the recording. Based on information and the evidence gathered during the course of the investigation, there is sufficient evidence to determine that staff were dinking alcohol while on duty. Therefore, the above allegation “Staff are engaging in behaviors that put the residents’ health and safety at risk” 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: 05/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20250513154404
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: 05/29/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/30/2025
Section Cited
HSC
1569.58
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a) The department may prohibit any person from being a licensee...,any employee, prospective employee, or person who is not a client and who has done any of the following: This requirement was not met as evidenced by:
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ED gave a progressive disciplinary action to all employees involved. ED will have a third-party vendor conducting training on appropriate work conduct and proper care and supervision of the residents. Schedule of training should be provided to LPA before POC due date.
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Based on interviews conducted and evidece received the three caregivers and one Med Tech were drinking during their scheduled work shift which poses an 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: 05/29/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3