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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850158
Report Date: 10/24/2025
Date Signed: 10/24/2025 09:04:42 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
08/22/2025 and conducted by Evaluator Valeria Conway
COMPLAINT CONTROL NUMBER: 29-AS-20250822064211
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:
05:00 PM
ALLEGATION(S):
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 Staff are not providing activities for 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 allegation. At 9:32 A.M. LPAs met with back-up administrator Agnes Gazaryan and explained the purpose of the visit. Marketing Director, Ashley Kumar arrived shortly after. Back-up Administrator is authorized to sign today's report. Entrance interview conducted.

During the initial 10-day inspection visit, between 10:05 A.M. and 4:22 P.M., the LPAs briefly toured the facility with the Marketing Director and back-up administrator. LPAs interviewed staff and random selected residents and obtained copies of pertinent documents relevant to the investigation. 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: 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 5
Control Number 29-AS-20250822064211
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 “Staff are not providing activities for residents in care” the Reporting Party (RP) expressed concern that the facility does not provide sufficient enrichment activities for residents. Interviews conducted with the Executive Director (ED), Monica Reyes, confirmed that the facility has experienced staffing challenges. The ED explained that when the facility is short-staffed, other personnel assist with resident activities as needed. For example, when the driver resigned on 02/07/2025, the Activity Director assumed the driving responsibilities. Subsequently, the staff member assigned to assist the front desk also resigned, and the Activity director was reassigned to cover the front desk duties. The ED further explained that activities cannot always be conducted as scheduled by the same employee in both units simultaneously as scheduled, acknowledging that there is no separate activity schedule tailored specifically for each unit, the Assisted Living (AL) and Memory Care (MC). During prior LPAs visits, staff were often not observed conducting activities offered by the facility. This was due either to the Activity Director covering the front desk or the Activity Director conducting activities in the AL unit, leaving no personnel available to provide activities for the MC residents. Resident interviews revealed that a new driver was hired on 8/5/2025, so that the Activity Director could resume assisting with activities as scheduled. However, due to the receptionist’s Part-time hours and departure on 9/24/2025, the Activity director has been assigned to cover front desk duties, resulting in limited activity programming. Interviews with the Activity Director confirmed that, due to staffing shortages and the lack of a receptionist, activities are not being conducted as planned. LPA observed that the facility provides the same activity schedule for both units. Additionally, LPA compared the facility's monthly activity schedule with the personnel report and observed that the activity schedule lists activities seven (7) days a week, whith the last activity starting at 6:00 P.M. However, the Activity Director is scheduled to work Monday through Friday from 8:30 A.M.to 5:00 P.M. Based on the information gathered during the investigation, the department has sufficient evidence to confirm this allegation occurred. Therefore, the allegation of “Staff are not providing activities for residents in care” has been SUBSTANTIATED at this time.

Continued on 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: 3 of 5
Control Number 29-AS-20250822064211
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 B
11/07/2025
Section Cited
CCR
87219(f)
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87219 Planned Activities (f) Planned Activities. In facilities licensed for fifty persons or more, one staff member shall have full-time responsibility to organize, and shall be given such staff assistance as… This requirement is not met as evidenced by…
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As of 9/14/2025, the Licensee hired a new Activity Director. Back-up Administrator agreed to develop an activity schedule tailored to the MC and to assign a staff member to regularly conduct activities (including weekends and after 5 PM) in both the AL and MC uint
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Based on interviews, the licensee did not comply with the section cited above as the facility lacks of sufficient personnel to conduct activities for all residents in care which posed a potential 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: 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: 4 of 5
Control Number 29-AS-20250822064211
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

A $250 civil penalty is assessed for the citation related to CCR 87219(f) for a repeat violation. The back-up Administrator, Agnes Gazaryan and Marketing Director, 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 5