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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850158
Report Date: 03/23/2026
Date Signed: 03/23/2026 05:44:38 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
03/09/2026 and conducted by Evaluator Kelly Dulek
COMPLAINT CONTROL NUMBER: 29-AS-20260309093143
FACILITY NAME:AASTA ASSISTED LIVINGFACILITY NUMBER:
565850158
ADMINISTRATOR:DENISE GILROYFACILITY TYPE:
740
ADDRESS:903 CARMEN DRIVETELEPHONE:
(805) 586-4191
CITY:CAMARILLOSTATE: CAZIP CODE:
93010
CAPACITY:130CENSUS: 69DATE:
03/23/2026
UNANNOUNCEDTIME BEGAN:
10:54 AM
MET WITH:Agnes Gazaryan, Facility DesigneeTIME COMPLETED:
05:50 PM
ALLEGATION(S):
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Facility staff did not appropriately respond to resident's request for assistance
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 the receptionist, who indicated neither the Administrator nor Facility Designee were present upon arrival. At approximately 12:00PM Facility Designee arrived at the facility. LPAs explained the purpose of the visit. Entrance interview conducted.

During today's visit, LPAs interviewed six (6) residents, three (3) staff and Facility Designee. LPA also attempted to review video footage from the date of the alleged incident. During an initial complaint visit conducted on 03/10/2026, the LPAs interviewed the Wellness Director at 11:48AM, toured the facility with Wellness Director at 12:14PM, and the LPAs reviewed and obtained copies of relevant documents. LPAs interviewed Facility Designee at 02:35PM. All documents obtained were reviewed during the course of the investigation. The following was then determined:
Report continued on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2026
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 2
Control Number 29-AS-20260309093143
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: AASTA ASSISTED LIVING
FACILITY NUMBER: 565850158
VISIT DATE: 03/23/2026
NARRATIVE
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The complaint alleges that on 03/04/2026, a female manager was wheeling a resident down the hallway, the resident indicated they needed to use the restroom and the manager left the resident alone in the hallway for 10-15 minutes. During today's visit, LPA attempted to review footage from 03/04/2026, however, footage was only available as far back as 03/11/2026. Facility Designee called the technician who recently serviced the recording system and the technician confirmed the system settings are configured to save footage for 20 days. However, technician stated that due to the amount of cameras installed and storage required to retain the 24-hour coverage recorded, the hard drive is not large enough to store the 20 days of footage. Interview with facility designee revealed that they had reviewed the footage, but it was too large to send to the Department. Facility Designee reviewed footage from all cameras for the date 03/04/2026 and did not observe any residents left in the hallway unattended in their wheelchairs. Interview with staff revealed that occasionally when staff are escorting residents to meals or activities, if they see a resident's call light on, they will stop to see what the resident needs before continuing on with the escort. However, no staff reported ever personally leaving a resident for a length of time or observing any resident left for any length of time. LPAs interviewed residents who use wheelchairs during the visit. One (1) resident interviewed did state they have been left in the hallway, but indicated they are able to wheel themselves in their wheelchair unassisted and do not require assistance. This resident was unsure of who the staff was when they were left in the hallway, the amount of time they were left, or how recently this occurred. All other residents interviewed have never been left, seen, nor heard of a resident being left in the hallway mid-escort. 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 is deemed UNSUBSTANTIATED at this time.

No citations issued. Exit interview was conducted. A copy of the report was provided.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2