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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850158
Report Date: 04/28/2026
Date Signed: 04/29/2026 08:20:42 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
10/27/2025 and conducted by Evaluator Valeria Conway
COMPLAINT CONTROL NUMBER: 29-AS-20251027093701
FACILITY NAME:AASTA ASSISTED LIVINGFACILITY NUMBER:
565850158
ADMINISTRATOR:REYES, MONICAFACILITY TYPE:
740
ADDRESS:903 CARMEN DRIVETELEPHONE:
(805) 586-4191
CITY:CAMARILLOSTATE: ZIP CODE:
93010
CAPACITY:130CENSUS: 59DATE:
04/28/2026
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Denise Gilroy and Agnes GazaryanTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Licensee does not allow residents to choose their own third-party health care provider
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Valeria Conway and Kelly Dulek conducted an unannounced subsequent complaint visit regarding the above noted allegation. Upon arrival, LPAs were greeted by Agnes Gazaryan, Facility Designee. At 10:30 A.M. Facility Administrator, Denise Gilroy joined the visit. LPAs explained the purpose of the visit. Entrance interview conducted.

During complaint visits conducted on 10/27/2025 and 03/10/2026, the LPAs conducted interviews with staff and residents, toured the facility, and the LPAs reviewed and obtained copies of relevant documents. All documents obtained were reviewed during the course of the investigation. 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: 04/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2026
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 6
Control Number 29-AS-20251027093701
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: 04/28/2026
NARRATIVE
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Continued from LIC 9099

On the allegation: “Licensee does not allow residents to choose their own third-party health care provider”, it was alleged that an outside physician affiliated with a hospice agency conducted assessments on several residents without their knowledge or consent. During the investigation, it was revealed that the Marketing Director and a hospice nurse requested copies of residents’ care plans for residents they believe may meet the criteria for hospice admission. Interviews conducted with residents revealed that a physician visited the facility to evaluate whether they qualified to receive additional assistance from outside nurses that are not employed by the facility. Residents stated that facility informed them that the assessment was intended to determine whether they would benefit receiving additional care services. However, residents reported they were not informed that the assessment could result in admission into hospice services if they qualified. Interviews further revealed that the residents, who were their own responsible parties at the time, did not participate in the decision to have the assessment conducted. Additionally, information obtained during the investigation revealed that the facility did not provide residents with a list of hospice agency options or allow residents to select a hospice provider of their choice. The facility arranged for one hospice particular agency and physician to conduct assessments. LPA interviewed a family member of one resident who confirmed that the assessment was conducted without the family’s knowledge and without approval or referral from the resident’s primary physician referral. 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 allow residents to choose their own third-party health care provider” has 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: 04/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2026
LIC9099 (FAS) - (06/04)
Page: 2 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
10/27/2025 and conducted by Evaluator Valeria Conway
COMPLAINT CONTROL NUMBER: 29-AS-20251027093701

FACILITY NAME:AASTA ASSISTED LIVINGFACILITY NUMBER:
565850158
ADMINISTRATOR:REYES, MONICAFACILITY TYPE:
740
ADDRESS:903 CARMEN DRIVETELEPHONE:
(805) 586-4191
CITY:CAMARILLOSTATE: ZIP CODE:
93010
CAPACITY:130CENSUS: 59DATE:
04/28/2026
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Denise Gilroy and Agnes GazaryanTIME COMPLETED:
03:15 PM
ALLEGATION(S):
1
2
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8
9
Staff are not properly trained or qualified
Facility is not following reporting requirements
INVESTIGATION FINDINGS:
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At 10:14 A.M. Licensing Program Analysts (LPAs) Valeria Conway and Kelly Dulek conducted an unannounced subsequent complaint visit regarding the above noted allegations. Upon arrival, LPAs were greeted by Agnes Gazaryan, Facility Designee. At 10:30 A.M. Facility Administrator, Denise Gilroy joined the visit. LPAs explained the purpose of the visit. Entrance interview conducted.

During complaint visits conducted on 10/27/2025 and 03/10/2026, the LPAs conducted interviews with staff and residents, toured the facility, and the LPAs reviewed and obtained copies of relevant documents. All documents obtained were reviewed during the course of the investigation. 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: 04/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2026
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 6
Control Number 29-AS-20251027093701
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: 04/28/2026
NARRATIVE
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Continued from LIC 9099

On the allegation: “Staff are not properly trained or qualified” it was alleged that Marketing Director, Facility Designee and Wellness Director lacked sufficient knowledge, experience, and understanding of regulations and procedures necessary to properly operate an RCFE (Residential Care Facility for the Elderly). Interviews conducted with the Facility Designee revealed that staff training consists of completing online training modules, including videos and quizzes, prior to interacting with residents. In addition to prior work experience, newly hired staff participate in hands-on shadowing with senior staff members during their first two (2) weeks following completion of the initial training. Interviews with residents and staff indicated that management staff, including the Wellness Director, demonstrate appropriate qualifications and experience during daily operations and interactions with residents. Residents interviewed stated that since the change in management, the facility has become more organized, and the environment has improved and become more welcoming. During the course of the investigation, LPAs reviewed training logs, employee files, and in-service training records for the Marketing Director, Facility Designee, and Wellness Director. Interviews with residents and staff revealed that the Marketing Director does not participate in resident care and supervision, but primarily performs administrative duties including scheduling, on boarding paperwork, and collecting payments, among other office-related responsibilities. Record reviews revealed that the Facility Designee has held an administrator certificate for several years. Review of the facility designee’s resume and work history reflected prior experience relevant to operating an RCFE, although records indicated they had not recently managed an RCFE facility. Records reviewed further revealed that staff that Wellness Director an individual with an LVN license, had completed required training in accordance with regulations, including dementia care, resident care and supervision, fire safety, and emergency preparedness training. 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 are not properly trained or qualified” is deemed unsubstantiated at this time.

Continued on LIC 9099-C

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

DATE: 04/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 29-AS-20251027093701
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: 04/28/2026
NARRATIVE
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Continued from LIC 9099-C

On the allegation: “Facility is not following reporting requirements”, it was alleged that management instructed staff not to report resident fall incidents. LPA interviewed six staff members who stated that staff complete internal incident reports to document unusual incidents occurring at the facility. Staff explained that the completed internal reports are provided to the Facility Designee, who then prepares and submits the required Unusual Incident Reports (SIR) to Community Care Licensing (CCL). Staff interviewed denied the allegation and did not express concerns regarding incidents not being reported. Interview with the Facility Designee revealed that staff are informed of the importance of reporting all incidents. The Facility Designee stated that all internal incident reports received from staff are reviewed and subsequently reported to CCL in accordance with reporting requirements. Additionally, they stated that residents’ primary physicians and responsible parties are notified regarding incidents involving residents. During the course of the investigation, LPA reviewed internal incident reports for September and October 2025 and compared them with incident reports submitted to CCL. LPA observed that the incidents documented internally during the reviewed time frame corresponded with the incidents reported to CCL. During the visit, LPA provided recommendations to the Facility Designee regarding reporting practices, including submitting reports prior to the seventh-day (7) deadline when possible and including follow-up information in incident reports submitted to CCL. The Facility Designee acknowledge the recommendations. 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 “Facility is not following reporting requirements” is deemed unsubstantiated at this time.

No citations are issued on this report. Exit interview.

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

DATE: 04/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 29-AS-20251027093701
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: 04/28/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/13/2026
Section Cited
CCR
87468.2(a)(7)
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87468.2 Additional Personal Rights...
(a) In addition...shall have..the... rights:
(7) ...The licensee shall provide necessary information and support to ensure that residents direct the planning of their care...
This requirement is not met as evidenced by:
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The licensee and their designee will submit a statement of understanding acknowledging the importance of including residents in participating in the planning of their care and providing residents the necessary info and options. Submit statement no later than POC due date.
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Based on interviews the licensee did not comply with the section cited above as residents were being assessed to get hospice services without their consent which poses a potential health risk to clients 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: 04/28/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2026
LIC9099 (FAS) - (06/04)
Page: 6 of 6