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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850158
Report Date: 08/12/2025
Date Signed: 08/13/2025 08:16:31 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
08/06/2025 and conducted by Evaluator Valeria Conway
COMPLAINT CONTROL NUMBER: 29-AS-20250806133828
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: 69DATE:
08/12/2025
UNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Monica ReyesTIME COMPLETED:
06:30 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 unannounce 10-day innicial complaint visit to investigate the allegation listed above. Upon arrival LPAs met with Executive Director/Administrator, Monica Reyes, and explained the reason for the visit.

During today’s visit from 11:23 A.M.– 1:00 P.M. LPAs and administrator toured the physical plant to ensure there are no health and safety concerns, and the facility is in compliance with Title 22 regulation. A case management report will be issued to address deficiencies observed during the physical plant tour. Additionally, LPAs interviewed staff, residents, and reviewed and obtained 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: 08/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2025
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-20250806133828
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: 08/12/2025
NARRATIVE
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Continued from LIC 9099

Throughout the course of the investigation, LPAs reviewed all documents obtained and conducted medication audit. The following was then determined:

Regarding allegation of “Staff are not dispensing medication as prescribed” it was alleged that resident medications were not being administered as scheduled, and this has resulted in the resident exhibiting aggressive behavior towards others. Furthermore, the Responsible Party (RP) stated that staff have been crushing Resident #1’s (R1) medication without a physician’s prescription. Interviews conducted with morning Med-Techs staff revealed that there are currently no residents refusing medications. The Med-Tech assigned to the Meadows (Memory care unit) stated that approximately one month ago, R1 had changes to two (2) of their prescribed medications. Staff also stated that R1's medication is currently being administered in a crushed form. LORazepam 0.5 mg to be given as routine medication and not as a PRN and QUEtiapine (generic for Seroquel) changed from 25 mg to 50 mg on 07/17/2025. During the course of the investigation, LPAs conducted a medication audit and reviewed Centrally Stored Medication and Destruction Record (CSMDR), Medication Administration Records (MARs), physician’s orders and pill count for R1. The following was observed, medication QUEtiapine 25 mg, 1 tablet two (2) times a day at 8 AM and 8 PM and also give one (1) every 12 hours as needed, was filled and given for the first time on 08/04/2025 with a starting quantity of one hundred and twenty (120). At the time of the audit, one hundred and four (104) pills remained in the medication container for QUEtiapine 25 mg. Based on medication count and interview with Med-Tech, staff continued administering 25 mg medication instead of the 50 mg that was prescribed on 07/17/2025. Additionally, the documentation review revealed that LORazepam 0.5 mg recorded as being administered daily at 8 P.M. on both the CSMDR and the MARs. However, on the Controlled Drug Record, the same employee who initialed the MARs documented the administration time as 5 P.M. It is therefore inconclusive what time the medication was actually given. Furthermore, LPAs observed discrepancies in the documentation for Atorvastatin 40 mg. The refill date on the medication label was 05/17/2025 and the “opened date” recorded by staff was 05/05/2025.

Continued on LIC 9099-C

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

DATE: 08/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 29-AS-20250806133828
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: 08/12/2025
NARRATIVE
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Continued on LIC 9099-C

LPAs requested documentation reflecting the date that LORazepam 0.5 and QUEtiapine 50 mg were changed from a PRN (as needed) medications to scheduled/routine medications, as well as documentation showing that R1 has a physician’s prescription authorizing their medication to be crushed. Med-Tech staff were unable to locate or provide the requested documentation at the time of the visit. 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.

As this is a repeat violation of the same regulation 87465(a)(4) within 12 months a civil penalty in the amount of $250 for a repeat violation is being assessed on the attached LIC 421FC. 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: 08/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 29-AS-20250806133828
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: 08/12/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/13/2025
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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The ED agreed to follow up with R1's physician to obtain clarification regarding the authorization for crushing medications.
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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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The Ed also stated they will issue a formal write-up and require Med-Tech staff to provide written statements acknowledging the importance of following physician orders and administering medications as scheduled.
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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: 08/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4