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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850158
Report Date: 10/24/2025
Date Signed: 10/31/2025 08:50:45 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: 69DATE:
10/24/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Agnes GazaryanTIME COMPLETED:
05:15 PM
ALLEGATION(S):
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Licensee does not ensure enough staff are present to meet the needs of residents
Staff do not provide adequate food service to residents
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 9:32 A.M. LPA met with back-up administrator Agnes Gazaryan, and explained the purpose of the visit. Back-up Administrator is authorized to sign today's report. Marketing Director, Ashley Kumar arrived shortly after. Entrance interview conducted.

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 prior visits, LPAs toured the physical plant, 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: 10/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2025
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 6
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: 69DATE:
10/24/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Agnes GazaryanTIME COMPLETED:
05:15 PM
ALLEGATION(S):
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9
Staff do not speak appropriately to residents in care
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 9:32 A.M. LPA met with back-up administrator Agnes Gazaryan, and explained the purpose of the visit. Marketing Director, Ashley Kumar, arrived shortly after. Facility's desegnee are authorized to sign today's report. Entrance interview conducted.

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 prior visits, LPAs toured the physical plant, 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
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 6
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: 10/24/2025
NARRATIVE
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Continued on LIC 9099-C

Regarding allegation of “Staff do not speak appropriately to residents in care” the RP expressed concern that staff demonstrate poor communication practices, including making inappropriate remarks such as telling residents to leave the facility if they are dissatisfied. Interviews conducted with residents and family members revealed mixed responses. Some residents and family members reported that there is a language barrier between staff and residents and that on certain occasions, staff members have used an unfriendly or dismissive tone when interacting with residents. Other residents denied experiencing any inappropriate behavior or communication issues with the staff. Interviews with staff denied the allegation and expressed that, at times, some residents can be verbally abusive or rude toward staff, which may lead to challenging interactions. The administrator stated that staff are continuously reminded to maintain professionalism when interacting with residents. Based on the above information gathered although the allegations may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the allegations “Staff do not speak appropriately to residents in care” is deemed unsubstantiated at this time.

Exit interview conducted and a copy of this report was provided.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 6
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: 10/24/2025
NARRATIVE
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Continued from LIC 9099

Regarding allegation “Licensee does not ensure enough staff are present to meet the needs of residents,” the Reporting Party (RP) expressed concern that the facility was short-staffed on Easter night (4/20), and the night of Saturday 5/10/25. Interviews with the Licensee and the ED confirmed that the facility has experienced staffing challenges. However, the ED stated that the facility maintains sufficient staffing levels to cover for employees who resign or call out due to illness using caregiver from a staff agency. LPA requested and reviewed facility timecards and staffing records, including any documentation of agency staff used to provide coverage during the specified dates. Per ED, agency personnel were not called in to cover staff call-outs on those days. LPA Conway conducted a comprehensive review of the facility’s timecards, which revealed that on 4/20/2025, five (5) scheduled staff members did not report to work, and on 5/10/2025, six (6) scheduled staff members did not report to work. Additionally, it was observed that some staff took their lunch breaks simultaneously rather than staggering their breaks which resulted in temporary service interruption and reduced supervision of residents. Staff reported feeling overworked and stressed due to persistent staffing shortages. They indicated that they are frequently required to assume additional responsibilities and take on extra shifts. Staff reported that this level of understaffing has led to them rushing through tasks leading to careless, delays in assisting residents, and longer response times to resident call signals. Interviews with residents revealed that occasionally staffing levels are insufficient to meet care needs of residents. Based on the information gathered during the investigation, the department has sufficient evidence to confirm this allegation occurred. Therefore, the allegation of “Licensee does not ensure enough staff are present to meet the needs of residents, has been SUBSTANTIATED at this time.

Continued from LIC 9099-C

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

DATE: 10/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 6
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: 10/24/2025
NARRATIVE
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Continued from LIC 9099-C

Regarding allegation “Staff do not provide adequate food service to residents” the RP expressed concern that there are often not enough staff available to feed residents in the Memory Care (MC) unit. Interviews conducted with the administrator revealed that the facility has experienced staff challenges due to staff call-outs, which have occasionally affected daily operations. However, the administrator denied that residents in the MC unit have ever missed meals or gone unfed. A review of group text messages among staff indicated that residents in the MC unit have complained of hunger on two (2) consecutive days due to not being served dinner. Interviews conducted with credible witnesses including staff, residents, and family members, revealed consistent concerns that residents are not receiving sufficient meals or snacks. Family members also reported taking upon themselves to bring additional food and snacks during their visits to ensure residents have enough to eat. Other residents also reported dissatisfaction with both the quantity and quality of the food. Based on the information gathered during the investigation, the department has sufficient evidence to confirm this allegation occurred. Therefore, the allegation of “Staff do not provide adequate food service to residents” has been SUBSTANTIATED at this time.

A $250 civil penalty is assessed for the citation related to CCR 87411(a) for a repeat violation. Facility designees, Agnes Gazaryan and Ashley Kumar were informed that additional civil penalties might be assessed based on health and safety code 1569.49(f).

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: 10/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 6
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: 10/24/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/27/2025
Section Cited
CCR
87411(a)
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87411(a) Personnel Requirements General (a) Facility personnel shall at all times be sufficient in numbers... In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure...This requirement is not met as evidenced by…
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Back-up administrator agreed to write a statement of understanding reg 87411 (a), submit a plan of action and ensure staff are not taking lunch at the same time. Statement due date 10/24/25.
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Based on interviews and record review the Executive Director did not comply with the regulation above by not having sufficient support staff to perform essential duties for residents in care which poses a potential health, safety and 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: 10/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6