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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850158
Report Date: 10/14/2024
Date Signed: 10/15/2024 08:14:14 AM

Unsubstantiated


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
08/07/2024 and conducted by Evaluator Valeria Conway
COMPLAINT CONTROL NUMBER: 29-AS-20240807114227
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: 80DATE:
10/14/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Monica ReyesTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff did not address a resident's behavior that posed a risk to other residents in care
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs), Valeria Conway and Kelly Dulek, conducted a subsequent complaint visit to the facility above to issue final findings of the allegation. Upon arrival, LPAs met with front desk staff. Administrator, Monica Reyes, was called via phone. At 11:35 a.m., Administrator arrived at the facility. Reason for the visit was explained. Entrance interview.

On 08/12/2024, from 9:30 A.M. – 2:15 P.M., LPAs initiated an unannounced complaint investigation for the allegation listed above. During the visit, LPAs toured the physical plant, interviewed staff, residents, resident Responsible Party (RP) and reviewed and obtained pertinent documents relevant to the investigation.
It was reported that “Staff did not address a resident's behavior that posed a risk to other residents in care” as it was alleged that staff did ensure to protect Resident #1 (R1) from another resident who was causing R1 distress.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2024
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-20240807114227
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: 10/14/2024
NARRATIVE
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Continued from LIC 9099

Information gathered during the course of the investigation revealed that R1 resided at this facility from 06/24/2024 to 07/31/2024. LPA conducted interviews with staff and resident. Staff stated that resident’s rooms are locked at all times including the side doors leading to the garden area. Additionally, staff explained that some residents might try to enter to a room that is not theirs, however, staff will re-direct them. LPA was unable to interview private caregiver. LPA requested evidence from Reporting Party (RP), however, RP was unable to provide it. Additionally, none of the staff had witnessed R2 inside R1’s bedroom. LPAs did not observe any residents attempting to enter other residents’ rooms during today’s visit. No other health and safety issues observed during today’s visit.

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 allegation “Staff did not address a resident's behavior that posed a risk to other residents in care” is deemed Unsubstantiated at this time.

Exit interview conducted. A copy of the report provided.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2