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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850158
Report Date: 12/11/2025
Date Signed: 12/12/2025 08:33:11 AM

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
08/26/2025 and conducted by Evaluator Valeria Conway
COMPLAINT CONTROL NUMBER: 29-AS-20250826092433
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: 71DATE:
12/11/2025
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH: Agnes GazaryanTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Facility does not have adequate emergency plans to meet the needs of all residents
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Valeria Conway and Martha Arroyo conducted an unannounced subsequent complaint visit to the facility above to deliver final findings of the complaint allegations. At 10:45 A.M. LPA met with facility designee Agnes Gazaryan and explained the purpose of the visit. Administrator, Denise Gilroy, was unavailable during today’s visit.

During the initial 10-day complaint, the LPAs briefly toured the facility with facility’s Marketing Director and back-up administrator. LPAs interviewed staff and randomly selected residents and obtained copies of pertinent documents relevant to the investigation.

During today’s visit, the LPAs conducted a plant tour at 12:07 P.M. to ensure there are no health and safety concerns. The following was determined.

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

DATE: 12/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
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-20250826092433
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: 12/11/2025
NARRATIVE
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Continued on LIC 9099

Regarding allegation “Facility does not have adequate emergency plans to meet the needs of all residents” the Reporting Party (RP) expressed concern that Memory Care (MC) residents are locked in their rooms unable to exit in the event of an emergency. Interviews conducted with staff revealed that residents are able to exit their rooms freely, as the doors are not locked from the inside. Facility representatives explained that in the MC unit, resident doors are equipped with storeroom locks which can lock from the outside but remain unlocked from the inside at all times. This measure was implemented due to incidents involving wandering residents attempting to enter other residents’ rooms, as well as residents forgetting which room belongs to them and attempting to open multiple doors. LPA observed a few residents wandering within the MC unit who attempted to open various doors. Also, LPA inspected eight (8) random resident rooms and confirmed that all locks lock from the outside but remain unlocked from the inside at all times. With regard to the allegation that the facility lacks an adequate emergency plan, facility representatives stated that all staff receive training and are assigned responsibilities and specific roles to ensure the safe evacuation and accounting of all residents during an emergency. The facility conducts emergency disaster drills and maintains an up-to-date Emergency Disaster Plan. LPA reviewed the most recent drill documentation and the updated Emergency Disaster Plan and found the facility to be in compliance with applicable regulations. Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the above allegation “Facility does not have adequate emergency plans to meet the needs of all residents” is deemed UNSUBSTANTIATED at this time.

No deficiency related to the allegations were cited. Exit interview conducted. A copy of the report was reviewed and provided.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
08/26/2025 and conducted by Evaluator Valeria Conway
COMPLAINT CONTROL NUMBER: 29-AS-20250826092433

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: 71DATE:
12/11/2025
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH: Agnes GazaryanTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Licensee did not ensure that oxygen tanks were properly stored
Licensee do not ensure staff are sufficiently trained
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Valeria Conway and Martha Arroyo conducted an unannounced subsequent complaint visit to the facility above to deliver final findings of the complaint allegations. At 10:45 A.M. LPA met with back-up administrator Agnes Gazaryan and explained the purpose of the visit. Administrator, Denise Gilroy, was unavailable during today’s visit.

During the initial 10-day complaint, the LPAs briefly toured the facility with facility’s Marketing Director and back-up administrator. LPAs interviewed staff and randomly selected residents and obtained copies of pertinent documents relevant to the investigation.

During today’s visit, the LPAs conducted a plant tour at 12:07 P.M. to ensure there are no health and safety concerns. The following was determined.

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

DATE: 12/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 29-AS-20250826092433
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: 12/11/2025
NARRATIVE
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Continued from LIC 9099

Regarding the allegations of “Licensee did not ensure that oxygen tanks were properly stored” and “Licensee do not ensure staff are sufficiently trained”, the Reporting Party (RP) expressed concern on how oxygen tanks are being stored inside resident’s rooms and indicated that the improper storage suggest staff may not be adequately trained. Interviews with staff, including housekeeping personnel, revealed that they could not recall the last time they received training on the proper storage of oxygen tanks. During the interviews, a housekeeper stated that staff responsible of cleaning and tidying residents' rooms often place the oxygen tanks on top of the concentrators while performing their duties. A facility representative further stated that staff training had not been provided on how to properly handle and store oxygen since beginning their employment several months ago. LPA requested documentation of the most recent staff training on proper oxygen handling and storage. The facility presented training conducted on 03/2024 where eight (8) Med-Techs attended this training; however, six (6) of them are not longer employed at the facility. Additionally, caregivers and housekeeping staff were not included in the training. During the visit, LPA entered rooms where oxygen was being used and observed unsecured oxygen tanks lying on their side on top of an oxygen machine and/or standing on the floor next to an oxygen machine. Based on the information gathered during the investigation, the department has sufficient evidence to confirm these allegations occurred. Therefore, the allegations of “Licensee did not ensure that oxygen tanks were properly stored” and “Licensee do not ensure staff are sufficiently trained” have been 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 9099-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: 12/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20250826092433
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: 12/11/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/26/2025
Section Cited
CCR
87618(b)(3)(E)and(5)
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87618 Oxygen Administration - Gas and Liquid (b)... (E)Oxygen tanks that are not portable shall be secured in a stand or to the wall and (5) Ensuring that facility staff have knowledge of, and ability in the operation of the oxygen equipment. This requirement was not met as evidenced by:
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Licensee will develop and maintain a current list of all residents who use oxygen, including their names and room numbers. Staff will conduct an inspection of these rooms to ensure that all oxygen tanks and concentrators are properly stored and secure in accordance with regulations and correct deficiencies immediately.
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Based on observation and interviews, the licensee did not comply with the section cited above per tour of the facility, it was observed oxygen tanks not being properly stored and staff are not up-to-date on how to handle and store oxygen tanks
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Also, the licensee will provide comprehensive training to all staff including housekeeping personnel on the proper handling and storage and submit proof of completed training before POC due date.
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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: 12/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5