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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850158
Report Date: 07/11/2025
Date Signed: 07/11/2025 06:53:07 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
05/20/2025 and conducted by Evaluator Valeria Conway
COMPLAINT CONTROL NUMBER: 29-AS-20250520120552
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: 72DATE:
07/11/2025
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Monica ReyesTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Licensee does not ensure staff are adequately trained
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Valeria Conway and Kelly Dulek conducted an unannounced subsequent complaint visit to the facility above to deliver final findings of the complaint allegations. At 10:17 A.M. LPA met with Executive Director, Monica Reyes, and explained the purpose of the visit.

On 05/20/2025, from 10:14 A.M.– 5:03 P.M., LPAs initiated an unannounced complaint investigation for the allegations listed above. During the visit, LPAs toured the physical plant at 10:20 A.M, interviewed staff, residents, and reviewed and obtained pertinent documents relevant to the investigation. Throughout the course of the investigation, LPA Conway reviewed all documents obtained, conducted telephonic and in person interviews with additional credible witnesses and other relevant parties. The following was then determined:

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

DATE: 07/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2025
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-20250520120552
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: 07/11/2025
NARRATIVE
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Continued from LIC 9099-C

It was reported that “Licensee does not ensure staff are adequately trained” as it was alleged that temporary agency staffing does not appear to be trained adequately.” Information gathered during the course of the investigation revealed that, due to ongoing staffing shortages, management made the decision to utilize a temp agency to fill in for staff who resigned or called out due to illness. Resident interviews revealed that both the temporary agency caregivers and the facility’s current and recently hired staff are not adequately trained to meet their care needs. Residents consistently reported that staff often appeared unsure of how to assist with their activities of daily living, such as bathing, dressing, transferring and toileting. Several residents expressed concerns that staff frequently did not know what to do or how to properly support them. Interviews with facility staff revealed concerns regarding proper training. While some staff reported that training is being provided regularly and they strive to meet residents’ needs, they also indicated that staffing shortages and extended work hours have impacted their ability to consistently provide quality care. A review of staff training records during the annual inspection on 04/29/2025, revealed that the facility uses an online provider to conduct annual training for their employees. However, training records were unavailable for four (4) out of eight (8) employees’ files reviewed, and one staff member had not received documented training since 2018. When LPA Conway requested training records and/or resumes for the temp agency caregivers, management were unable to provide any documentation to verify training or prior work experience. The Marketing Director and the Administrator stated they had requested the documentation form the agency, and while the agency initially indicated they would email the records, they later stopped responding to phone calls and emails. LPA Conway requested copies of any email correspondence, but these were not provided. Based on the information gathered during the course of the investigation, record review, and lack of documentation, there is sufficient evidence to determine that both facility staff and temp agency caregivers were not sufficiently trained. Therefore, the above allegation “Licensee does not ensure staff are adequately trained” 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 809-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: 07/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 29-AS-20250520120552
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: 07/11/2025
NARRATIVE
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Continued on LIC 9099-C

Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 809-D.) Administrator was informed that failure to correct the deficiencies may result in civil penalties.

A $250 immediate civil penalty is assessed today for repeat violation of 1569.312(a) Basic Services as licensee was previously cited on 10/14/2024. The Executive Director/Administrator, Monica Reyes, was informed that additional civil penalties might be assessed based on Health and Safety Code 1569.49(e) and 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: 07/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20250520120552
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: 07/11/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/14/2025
Section Cited
CCR
87411(c)(6)
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(6) The licensee shall maintain documentation pertaining to staff training in the personnel records...For on-the-job training, documentation shall consist of a statement or notation, made by the trainer, of the content covered in the training... This requirement is not met as evidenced by:
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The Administrator will conduct a comprehensive review of all staff training records to identify any staff members who are not up to date with their required training.
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Based on record review, the licensee did not comply with the section cited above by not providing adecuate training to staff and not verifiying training for agency staff, which poses/posed a potential health, safety or 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: 07/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2025
LIC9099 (FAS) - (06/04)
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