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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850158
Report Date: 08/16/2024
Date Signed: 08/16/2024 02:55:51 PM

Unsubstantiated


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
07/01/2024 and conducted by Evaluator Teresa Camara
COMPLAINT CONTROL NUMBER: 29-AS-20240701105839
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: 77DATE:
08/16/2024
UNANNOUNCEDTIME BEGAN:
12:49 PM
MET WITH:Esmeralda ElizarrarazTIME COMPLETED:
03:05 PM
ALLEGATION(S):
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Staff did not prevent residents from wandering away from the facility
Staff do not respond to residents call for assistance in a timely manner
Staff do not ensure that residents are adequately fed
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Teresa Camara conducted a subsequent complaint investigation visit. LPA met briefly with Administrator Monica Reyes but she had to leave for an appointment. LPA was assisted by the Resident Care Coordinator (RCC) Esmeralda Elizarraraz. LPA explained the reason for the visit.

During today's visit, 8/16/2024, LPA conducted interviews with nine (9) residents starting at 12:52 p.m. On 7/8/2024, LPA had conducted interviews with administrator starting at 10:42 a.m., interviews with multiple staff starting at 11:38 a.m., record review starting at 2:50 p.m., and interviewed one resident starting at 3:14 p.m.

Regarding the allegation: Staff did not prevent residents from wandering away from the facility.
The complaint indicated there were two elopements on Saturday, 6/29/2024. LPA interviewed staff who worked that day. Nobody was aware of any elopements. The staff in memory care denied that any memory

(continued on LIC9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 593-4347
LICENSING EVALUATOR NAME: Teresa CamaraTELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024
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 2
Control Number 29-AS-20240701105839
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: 08/16/2024
NARRATIVE
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(continued from LIC9099)

care resident left the facility. Staff stated the assisted living resident who allegedly eloped can actually leave the facility without supervision. LPA spoke with that resident, resident 1 (R1). R1 stated they enjoy walking outside of the facility. They do not go far, usually they just walk around the perimeter of the facility. R1 recalled being asked by staff not to go in the area next to the barranca so they avoid that area now. LPA confirmed on R1's physician's report they could leave without assistance. Based on interviews and record review, this allegation is deemed Unsubstantiated at this time.

Regarding the allegation: Staff do not respond to residents call for assistance in a timely manner.
LPA interviewed a total of ten (10) residents. Residents stated staff usually respond to their calls for assistance within ten (10) minutes or less. A couple residents indicated they have had to wait up to twenty (20) minutes during busy times in the morning when everyone is waking up. None of the residents were concerned about wait times for assistance. Some residents voiced concern that the facility could use more staff sometimes but they personally did not feel neglected nor did they feel they had to wait for too long. The staff who were interviewed by LPA all indicated they try to respond to any calls for assistance immediately or within ten (10) minutes. Based on interviews, this allegation is deemed Unsubstantiated at this time.

Regarding the allegation: Staff do not ensure that residents are adequately fed.
LPA interviewed a total of ten (10) residents. All residents indicated they like the food and they get plenty of food. They can have second helpings of food too. All the residents stated if they do not like what is being served they can ask for another option such as a burger, sandwich, veggie burger, quesadilla, etc. All the residents stated if they were not able to make it to a mealtime, for example if they left for an appointment and returned after the lunch period, they can still get something to eat. They can request the meal be set aside or they can just ask for a sandwich or something like that upon their return. They can also just request a snack, such as yogurt. Staff who were interviewed by LPA also stated meals are set aside in the refrigerator and heated up if a resident does not want to eat during the mealtime. They also provide residents with sandwich options or other snacks. Based on interviews, this allegation is deemed Unsubstantiated at this time.

No deficiencies observed. Exit interview conducted and report issued.
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 593-4347
LICENSING EVALUATOR NAME: Teresa CamaraTELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2