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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850158
Report Date: 06/25/2026
Date Signed: 06/30/2026 10:43:43 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
05/29/2025 and conducted by Evaluator Valeria Conway
COMPLAINT CONTROL NUMBER: 29-AS-20250529054144
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:0CENSUS: 0DATE:
06/25/2026
UNANNOUNCEDTIME BEGAN:
04:39 PM
MET WITH:Narinder KumarTIME COMPLETED:
06:00 PM
ALLEGATION(S):
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Due to insufficient staffing, facility residents sustained multiple injuries due to falls
Facility staff failed to seek timely medical care for resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Valeria Conway conducted a subsequent complaint visit with the purpose of delivering findings for the above noted allegations. Due to the closure of the facility effective 05/11/2026, today’s visit was conducted telephonically with former licensee representative, Narinder Kumar. Entrance interview conducted.

On 05/29/2025, The Department received a complaint of neglect/lack of care and supervision. It was alleged that due to insufficient staffing several residents at the facility sustained injuries due to multiple falls and that the facility staff failed to seek timely medical care for resident. It was further reported that Resident #1 (R1) sustained a fall and broke a bone. Resident #2 (R2) was hospitalized after a fall that occurred on 04/18/2025, resulting in a broken arm, and Resident # 3 (R3) experienced a fall on 05/28/2025 which resulted in a cut on the forehead along with a skin tear on the arm.

Continued on LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2026
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-20250529054144
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: 06/25/2026
NARRATIVE
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Continued from LIC 9099

Per the Reporting Party (RP) Resident #4 (R4) also sustained multiple falls while at the facility and that staff did not call emergency transport to take the resident to the ER after sustaining a fall. The complaint was referred to the Community Care Licensing Investigations Branch (IB).

During an initial complaint visit on 05/29/2025 between 10:30AM and 04:45PM, LPAs Valeria Conway, Martha Arroyo and Kelly Dulek and Licensing Program Manager (LPM), Kristin Heffernan, briefly toured the facility with former Executive Director (ED), Monica Reyes. LPA Arroyo conducted a medication audit. LPAs and LPM interviewed the former ED, conducted a file review and obtained copies of pertinent documents relevant to the investigation.

IB Investigator conducted both telephonic and in-person interviews with staff, residents, and other relevant parties on the following dates: 06/12/2025, 06/17/2025, and 08/07/2025. Additionally, IB Investigator also obtained and reviewed copies of medical records for all four (4) residents from St. John’s Hospital.

Resident #1 (R1) was admitted to the facility on 10/18/2017. R1’s primary diagnosis included Parkinson’s disease, bipolar disorder, anxiety disorder, and dementia. R1 requires full assistance with ADLs, including personal hygiene, medication administration, and mobility. R1 is non-ambulatory and relies on a wheelchair, requiring two-person assistance for transfers and toileting, as well as 15-minute checks due to being a high fall-risk status. Despite these needs, R1 sustained multiple falls at the facility. On 04/06/2025, R1 fell from her wheelchair and sustained an intertrochanteric femur fracture. On 05/04/2025, R1 was found on the floor with no injuries. On 05/11/2025, R1 fell again while attempting to rise from bed, resulting in a comminuted left hip fracture requiring surgical intervention. These incidents occurred during a period of significant staffing shortages, during which increased supervision required by R1’s care plan was not consistently provided.



Resident #2 (R2) was admitted to the facility on 03/24/2025. R2’s primary diagnoses include dementia (moderate Alzheimer’s), diabetes, a prior left femur fracture, and left wrist/radius fractures. R2 is confused and disoriented at baseline and requires maximum assistance for grooming and dressing, is dependent for bathing and toileting, and is unable to manage R2s medications. Although ambulatory, R2 has poor balance and is at very high risk for falls.

Continued on LIC 9099-C
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 29-AS-20250529054144
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: 06/25/2026
NARRATIVE
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Continued from LIC 9099-C

On 04/07/2025, R2 was found on the floor without injuries. On 04/18/2025, R2 sustained a fall resulting in a broken arm. On 05/23/2025, R2 experienced another unwitnessed fall and suffered a displaced distal radius and ulnar styloid fracture, which required splinting after the ER was unable to reduce the fracture. On 06/10/2025, R2 slipped on water and hit R2s head, though without major injury. Despite repeated falls, R2s care plan was not updated, and monitoring was not increased during the period of facility understaffing.
Resident # 3 (R3) was admitted to the facility on 05/14/2024. R3 has advanced dementia and multiple chronic medical conditions, including Type 2 diabetes, hypertension, coronary artery disease, hyperlipidemia, and a history of CABG surgery and sepsis. R3 requires assistance with dressing, grooming, and medication management, and although documented as non-ambulatory in facility records, medical documentation shows R3 ambulated independently within the memory care unit, often without using assistance, contributing to frequent falls. R3 experienced several falls at the facility. On 02/05/2025, R3 sustained a head injury after being pushed by another resident. On 02/23/2025 and 03/21/2025, R3 suffered unwitnessed falls with head contusions and skin injuries. On 05/25/2025, R3 fell again, sustaining additional head and hand injuries. On 05/28/2025, R3 experienced a fall resulting in multiple rib fractures. During this event, the NOC Med-Tech did not contact emergency services or provide first aid, delaying care until the morning shift.

Resident # 4 (R4) was admitted to the facility on 09/13/2024. R4 has severe dementia as well as hypertension, COPD, hyperlipidemia, depression, and a history of breast cancer. Prior to R4s fall-related injury, R4 was ambulatory with a walker but required close supervision due to significant cognitive impairment. R4 required hands-on assistance with ADLs and safety monitoring. On 07/05/2025, R4 sustained a fall that resulted in a right leg/hip fracture. Internal staff communications showed discrepancies between what staff witnessed and what was documented in the incident report. On 07/06/2025, R4 underwent hip-repair surgery. Following surgery, R4 exhibited severely limited mobility, only able to take a few assisted steps, and required skilled nursing facility-level rehabilitation.

Continued on LIC 9099-C
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 29-AS-20250529054144
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: 06/25/2026
NARRATIVE
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Continued from LIC 9099-C

Information gathered during the course of the investigation reflected that the facility was operating with critically insufficient staffing levels during April and May 2025. Multiple caregivers and Med-Techs resigned without notice, leaving the facility unable to meet required staffing ratios, particularly during the NOC shift. Interviews confirmed that required 15-minute safety checks were not consistently conducted during this period. Although rounds logs were initialed by staff, staff reported they were unable to complete checks as required due to inadequate personnel. During the same timeframe, residents sustained multiple falls. Several resulted in fractures requiring hospital treatment. All falls were unwitnessed, and there was no evidence that the facility updated residents’ Needs & Services Plans or increased monitoring despite repeated incidents and documented fall risks.

Based on the information gathered, the Department has sufficient evidence to support allegations, “Due to insufficient staffing, facility residents sustained multiple injuries due to falls” and “Facility staff failed to seek timely medical care for resident.” Therefore, the above allegations are deemed 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.) A $250 immediate Civil Penalty was assessed for a repeat violation within the past twelve (12) months. Licensee was informed that additional civil penalties might be assessed based on health and safety code 1569.49(f).

Exit interview conducted telephonically, a copy of this report and the appeals will be sent to the licensee via email and certified mail. LPA requested licensee sign and return report to the LPA.

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

DATE: 06/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20250529054144
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: 06/25/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/25/2026
Section Cited
CCR
87411(a)
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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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No plan of correction required. Facility closed on 05/11/2026.
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Based on interviews and record review the Licensee did not comply with the regulation above by not having sufficient support staff and supervision to perform essential duties for residents in care which poses an immediate safety risk to residents in care.
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Type A
06/25/2026
Section Cited
CCR
87466
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The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional...When changes such as unusual...physical health condition...responsible person, if any. This requirement was not met as evidenced by:
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No plan of correction required. Facility closed on 05/11/2026.
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Based on interviews, and records review the Licensee did not obtain timely medical attention for several residents in care which posed an immediate health and safety concern 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: 06/25/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5