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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850158
Report Date: 07/22/2025
Date Signed: 07/23/2025 09:41:09 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
05/20/2025 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:
07/22/2025
UNANNOUNCEDTIME BEGAN:
03:58 PM
MET WITH:Monica ReyesTIME COMPLETED:
06:00 PM
ALLEGATION(S):
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Staff are not dispensing medication as prescribed
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 9:41 A.M. LPAs met with Executive Director, Monica Reyes, and explained the purpose of the visit.

On 05/20/2025, LPAs initiated an unannounced complaint investigation for the allegations listed above. During the visit and on a subsequent visit on 07/11/2025, LPAs toured the physical plant, interviewed staff, residents, and reviewed and obtained pertinent documents relevant to the investigation. During today’s visit, LPAs conducted a health and safety check tour of the facility at 11:19 A.M. During the walk-through, LPAs observed deficiencies unrelated to the complaint allegations, which will be addressed in a case management report. Throughout the course of the investigation, LPA Conway reviewed all documents previously 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: 07/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
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-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: 07/22/2025
NARRATIVE
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Continued from LIC 9099

Regarding allegation of “Staff are not dispensing medication as prescribed” it was alleged that resident medications were not being delivered on time. During the course of the investigation, LPAs conducted a medication audit and reviewed the Medication Administration Records (MARs) for two residents. The review revealed that Resident #1 (R1) had discrepancies with two medications. The PRN medication Lorazepam 0.5 mg, 1 tablet up to 2 times per day as needed, was filled on 06/05/2025 with a quantity of six (6). At the time of the audit, only two (2) pills remained in the medication container for Lorazepam and the MARs log for June and July 2025 did not reflect any documentation of administration. Also, Quetapine (generic for Seroquel) 50 mg, 1 tab every morning, 2 tabs in the afternoon and 4 tabs at bedtime, with a start date of 07/03/2025 containing 100 pills had 17 pills left, however if administered as prescribed, should have been empty as of 07/17/2025. MARs log from 07/15/2025-07/22/2025 was incomplete. The absence of MedTech initials on the MAR indicates that medication was not recorded as having been dispensed to the resident. LPAs observed that medications for all residents were being stored in two (2) medication carts positioned against the wall adjacent to the file room. At 1:19 P.M., LPAs observed several loose pills on the floor between the two (2) medication carts. When the carts were pulled away from the wall, LPAs and Med-Techs present discovered several unidentified pills scattered on the floor. Med-techs stated they were unaware of those pills and were unable to identify which resident(s) the medications belonged to. Based on interview and record review, the preponderance of evidence standard has been met; therefore, the allegations above are deemed SUBSTANTIATED at this time.

Pursuant to Title 22 of the California Code of Regulations Division 6, Chapter 8, the following deficiencies were cited (refer to LIC 9099-D). Failure to correct the deficiencies may result in additional civil penalties.

A $250 civil penalty is assessed today for the citation related to CCR 87465(a)(4) for repeat violation within 12 months. 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. A copy of the report and appeal rights were provided.

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

DATE: 07/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
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: 07/22/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/23/2025
Section Cited
CCR
87465(a)(4)
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A plan for incidental medical and dental care shall be developed by each facility. The plan shall...provide for assistance in obtaining such care...The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by:
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ED has agreed to conduct a meeting with all staff responsible for dispensing medications. Per ED each staff member involved will issue a formal write-up as appropriate. All staff will read and write a statement of understanding on regulation cited.
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Based on medication review, the Licensee did not comply with the section cited above as medication audit revealed discrepancies for R1 which poses an immediate 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: 07/22/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
LIC9099 (FAS) - (06/04)
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