565850158-1-26-2026-29-AS-DPEA-DRGQQA-20260220112201

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565850158
Report Date: 01/26/2026
Date Signed: 01/26/2026 02:44:54 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 LIVING		FACILITY NUMBER:	565850158
ADMINISTRATOR:	REYES, MONICA		FACILITY TYPE:	740
ADDRESS:	903 CARMEN DRIVE		TELEPHONE:	(805) 586-4191
CITY:	CAMARILLO	STATE: CA	ZIP CODE:	93010
CAPACITY:	130	CENSUS: 72	DATE:	01/26/2026
		UNANNOUNCED	TIME BEGAN:	11:17 AM
MET WITH:	Agnes Gazaryan		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff did not ensure that resident's hygiene needs are being met

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. LPA met with back-up administrator/facility designee, Agnes Gazaryan and explained the purpose of the visit. During today’s visit a brief physical plant tour was conducted.

During initial 10-day complaint inspection and subsequent visits, the LPAs briefly toured the facility with facility’s Marketing Director, Ashley Kumar and back-up administrator. LPAs interviewed staff and randomly 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: 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 4

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: 01/26/2026

NARRATIVE

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Continued from LIC 9099

Regarding allegation “Staff did not ensure that resident's hygiene needs are being met” it was the Reporting Party’s (RP’s) concern that Resident #1 (R1) had not been showered, had run out of shampoo, and that overall hygiene needs were not being adequately addressed at the facility. Interview with management revealed that the facility has experienced staffing challenges, however, caregivers reported that assigned care tasks are being completed. Management further explained that family members are responsible for providing resident’s personal hygiene items including shampoo. Management stated that if a resident runs out of hygiene supplies, the facility will provide these items at no additional cost. Staff interviews indicated that they are assigned specific daily duties, including assisting residents with showers and with incontinence care needs. Staff reported that due to short staffing required basic services such showering are sometimes delayed and not consistently provided. Staff also stated that when a resident declines assistance with showering, caregivers may request support from another staff member, however, the initial caregiver does not always follow up to confirm whether the grooming task was completed. Regarding the availability of hygiene supplies, staff stated that in some instances residents’ personal hygiene items are depleted because they are shared or used when other residents run out, and the facility does not always immediately replace these items. Resident and credible witnesses interviews revealed mixed responses. Some residents reported that their incontinence and basic care needs are being met, while others stated their needs are not consistently met due to short staff, language barriers and concerns that night shift staff are not completing required tasks. The LPA attempted to interview R1; however, R1 appeared uncomfortable answering questions and declined to comment on this matter. 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 ensure that resident's hygiene needs are being met” 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 4

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: 01/26/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 01/27/2026 Section Cited CCR 87464(f)(1)	1 2 3 4 5 6 7	87464(f)(1) Basic Services (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Facility designee created a daily log to ensure compliance with the daily shower schedule. A statement of understanding on regulation cited will be sent to LPA before POC due date.
	8 9 10 11 12 13 14	Based on interviews, the licensee did not comply with the section cited above by not not following shower schedules which posed a immediate personal to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: 3 of 4

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: 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)

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