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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850158
Report Date: 01/26/2026
Date Signed: 01/26/2026 02:41:21 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
09/19/2025 and conducted by Evaluator Valeria Conway
COMPLAINT CONTROL NUMBER: 29-AS-20250919123526
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:
01/26/2026
UNANNOUNCEDTIME BEGAN:
11:17 AM
MET WITH:Agnes GazaryanTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility does not have sufficient staffing to meet residents' needs
Staff did not safeguard resident's personal belongings
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 11:17 A.M. LPAs met with the facility designee, Agnes Gazaryan, and explained the purpose of the visit. During today's visit, a brief physical plant tour was conducted.

On 09/26/2025, LPA Conway initiated an unannounced complaint investigation for the allegations listed above. During the initial complaint visit LPA briefly toured the physical plant, interviewed the back-up administrator/facility designee, Resident #1, staff and reviewed and obtained pertinent documents relevant to the investigation. Throughout the course of the investigation, LPA Conway reviewed all documents obtained, conducted interviews with additional credible witnesses and other relevant parties. 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: 01/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026
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-20250919123526
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: 01/26/2026
NARRATIVE
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Continued from LIC 9099

Regarding allegation “Facility does not have sufficient staffing to meet residents' needs” it was reported that due to inadequate staffing levels, residents’ needs are not consistently being met. The Marketing Director, Ashley Kumar, stated that in occasions staff call out; however, the facility utilizes a staffing agency to cover shifts when employees fail to report for duty. The representative further stated that on some occasions it is difficult to obtain coverage due to short notice from staff who do not come to work. In such instances, caregivers on duty are asked to remain beyond their scheduled shifts to provide partial coverage. Staff interviews revealed that required tasks are often not completed because although the facility schedules an adequate number of personnel, not all scheduled staff report for duty. Additionally, staff reported that caregivers provided through the staffing agency are frequently unfamiliar with the facility and residents’ needs, and in some cases are unable to perform assigned duties. AM shift staff stated that at the beginning of their shift, several residents are observed to be wet and soiled, and assistance with incontinence care has not been completed. Residents interviewed revealed ongoing concerns regarding staffing levels across all shifts. Several residents stated that it is difficult to receive timely assistance during the night shift and that staff do not check on them as frequently as needed. LPA Conway requested and reviewed facility timesheets for the month of September 2025, with specific analysis of staffing on September 18 and September 19, 2025. Review of the records revealed that during the night shift hours of approximately 2:30 AM to 6:30 AM, there were only two (2) facility staff and one (1) agency staff assigned to provide care for approximately seventy (70) residents. Additionally, review of the timesheets identified multiple scheduled caregivers who failed to report for duty during their assigned shifts. Based on the information gathered during the investigation, the department has sufficient evidence to confirm this allegation occurred. Therefore, the allegation of “Facility does not have sufficient staffing to meet residents' needs” has been SUBSTANTIATED at this time.

Continued on LIC 9099-C

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

DATE: 01/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 29-AS-20250919123526
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: 01/26/2026
NARRATIVE
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Continued from LIC 9099-C

Regarding allegation “Staff did not safeguard resident's personal belongings” it was reported that a caregiver stole money from a resident and the administrator failed to take appropriate action. An interview with the backup administrator/facility designee, Agnes Gazaryan and Marketing Director, Ashley Kumar, revealed that staff reported the allegation to management, and a meeting was conducted with Resident #1 (R1) to gather additional information regarding the incident reported. During this meeting R1 denied that any staff member stole money from them. The facility representative acknowledged that, for several days following the allegation and R1’s consent, the resident’s wallet was secured in a locked cabinet for safekeeping. The facility representative further stated that after a few days, R1 requested that their wallet be returned, and the request was honored. An interview with R1 revealed that they frequently ask facility drivers to transport them to the bank to withdraw money and often request facility staff to purchase hygiene products on their behalf. During the interview, R1 denied tipping or providing money to staff for these additional services. LPA requested receipts for the reported purchases; however, R1 was unable to provide documentation. During the interview, the resident appeared forgetful and repetitive when recounting events. Staff interviewed acknowledged purchasing some hygiene items for residents, however, they denied receiving tips of stealing money. LPA reviewed R1’s most recent Physician’s Report dated January 24, 2025. Under the mental condition section, the physician indicated that R1 is not able to manage their cash resources, with a comment stating that family manages the resident’s finances. Additionally, review of the resident Pre-Placement Appraisal Information form date January 25, 2025, signed by Administrator, Monica Reyes, indicated the resident’s mental condition as “mild forgetfulness” and the section indication assistance with managing personal cash resources was marked “yes.” LPA reviewed the facility’s operation plan and does not have a surety bond or policy or procedure in place to safeguard resident cash resources in instances where residents are unable to independently manage their finances. Based on the information gathered during the investigation, the department has sufficient evidence to confirm this allegation occurred. Therefore, the allegation of “Staff did not safeguard resident's personal belongings” has been SUBSTANTIATED at this time.

Continued on LIC 9099-C

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

DATE: 01/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 29-AS-20250919123526
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: 01/26/2026
NARRATIVE
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Continued from LIC 9099-C

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.

An immediate civil penalty of $1,000 repeat violation is assessed today due to being cited for the same violation within 12 months. Administrator was informed that additional civil penalties might be assessed based on Health and Safety Code 1569.49(e) and 1569.49(f).

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: 01/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20250919123526
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: 01/26/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/27/2026
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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Licensee agreed to adjust schedules to prevent lapses in coverage and create a backup/on call staff list in the event of call-offs or emergencies. Changes to schedule and on call list will be provided to LPA before POC due date.
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Based on interviews and record review the Licensee did not comply with the regulation above by not having sufficient staff during the NOC shift to perform essential duties for residents in care which poses a immediate health, safety and personal rights risk to residents in care.
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Type A
01/27/2026
Section Cited
CCR
87217(a)
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Safeguards for Resident Cash, Personal Property, and Valuables (a) A licensee shall not be required to handle residents' cash resources. However, if a resident incapable of handling his own cash resources... This requirement is not met as evidenced by…
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Licensee agreed to contact R1's ohysician for a revaluation and to assess R1's condition to manage their resousces. Also, to get a public conservator. Email communication will be send to LPA prior to POC Due date.
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Based on interviews and record review the Licensee did not comply with the regulation above by allowing R1 to manage their cash resources which poses a immediate 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: 01/26/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5