Inspection Reports for Aegis Living Ventura
4964 Telegraph Rd, Ventura, CA 93003, CA, 93003
Back to Facility ProfileInspection Report Summary
Most inspections found no deficiencies, and several complaint investigations were unsubstantiated, indicating that allegations of neglect or inadequate care were not supported by evidence. The facility’s most recent report from September 11, 2025, was a complaint investigation that found no deficiencies and deemed the complaint unsubstantiated. Earlier inspections identified some deficiencies related mainly to staff criminal record clearance and medication documentation, as well as occasional environment and safety issues such as unsecured chemicals and medication carts, some of which posed immediate risks but were corrected promptly. There were no fines, license suspensions, or enforcement actions listed in the available reports. The overall trend shows improvement, with the most recent inspections free of deficiencies after addressing prior issues.
Deficiencies (last 5 years)
Deficiencies (over 5 years)
2.4 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
40% better than California average
California average: 4 deficiencies/yearDeficiencies per year
8
6
4
2
0
Census
Latest occupancy rate
66% occupied
Based on a September 2025 inspection.
This facility has shown a decline in demand based on occupancy rates.
Census over time
Inspection Report
Complaint Investigation
Census: 66
Capacity: 100
Deficiencies: 0
Date: Sep 11, 2025
Visit Reason
The inspection was conducted as a complaint investigation following an allegation that staff did not ensure adequate supervision, resulting in a resident sustaining injury.
Complaint Details
The complaint alleged that due to lack of supervision, Resident #1 fell resulting in a hip fracture. The investigation included interviews, document reviews, and observations. It was found that staff were present during the incident, and the resident was typically independent with transfers. The allegation was unsubstantiated due to lack of sufficient evidence.
Findings
The investigation found that although the resident did fall and sustain a hip fracture, staff were present and the resident did not require 1:1 supervision. There was insufficient evidence to substantiate the allegation of inadequate supervision, and the complaint was deemed unsubstantiated.
Report Facts
Residents present during incident: 15
Care staff working: 3
Care staff supervising residents: 2
Facility capacity: 100
Facility census: 66
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kelly Dulek | Licensing Program Analyst | Conducted the complaint investigation |
| John Washko | General Manager | Interviewed during investigation |
| Aleesha Zuniga | Health Services Director | Interviewed during investigation |
| Kristin Heffernan | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Annual Inspection
Census: 61
Capacity: 100
Deficiencies: 0
Date: Jul 23, 2025
Visit Reason
The inspection was an unannounced required annual visit to evaluate the facility's compliance with licensing regulations and health and safety standards.
Findings
The facility was found to be in compliance with all applicable regulations, with no deficiencies cited. The inspection included review of fire safety systems, resident rooms, bathrooms, common areas, grounds, infection control, records, medication management, kitchen, and interviews with residents and staff.
Report Facts
Resident rooms observed: 11
Resident files reviewed: 5
Staff files reviewed: 5
Medications reviewed: 2
Non-perishable food supply: 7
Perishable food supply: 2
Resident interviews conducted: 5
Staff interviews conducted: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| John Washko | General Manager | Met with Licensing Program Analyst during inspection |
| Kelly Dulek | Licensing Program Analyst | Conducted the inspection and authored the report |
| Kristin Heffernan | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Census: 70
Capacity: 100
Deficiencies: 1
Date: Jun 6, 2025
Visit Reason
An unannounced case management visit was conducted to issue an amended report related to a previous annual inspection citation for Criminal Record Clearance.
Findings
The report revises a citation issued on 07/23/2024 regarding a failure to obtain a transfer of criminal record clearance for one staff member, posing a potential health, safety, or personal rights risk to persons in care.
Deficiencies (1)
One staff member did not have a transfer of criminal record clearance prior to working, residing, or volunteering in the licensed facility.
Report Facts
Deficiency Plan of Correction Due Date: Jul 23, 2024
Census: 70
Total Capacity: 100
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Erica Mosley | Licensing Program Analyst | Conducted the unannounced case management visit and signed the report |
| Kasandra Lopez | Licensing Program Manager | Named as Licensing Program Manager on the report |
| Lance Shenk | Administrator/Director | Facility Administrator/Director |
| Brittany Cramer | Marketing Director | Met with Licensing Program Analyst during the visit |
Inspection Report
Complaint Investigation
Census: 66
Capacity: 100
Deficiencies: 0
Date: Apr 21, 2025
Visit Reason
An unannounced complaint investigation visit was conducted in response to allegations received on 2024-03-18 regarding medication protocol, response to resident call pendants, special diet orders, and cancellation of medical appointments at Aegis Living Ventura.
Complaint Details
The complaint included allegations that staff did not follow medication protocol, did not respond timely to resident call pendants, did not follow special diet orders, and canceled a resident's medical appointment. After investigation, all allegations were found to be unsubstantiated based on interviews, record reviews, and observations.
Findings
All allegations were investigated through staff and resident interviews, record reviews, and observations. The investigation found that medication protocols were followed, staff responded timely to call pendants, special diet orders were adhered to, and no staff cancellations of medical appointments occurred. All allegations were deemed unsubstantiated.
Report Facts
Capacity: 100
Census: 66
Pendant calls: 93
Average pendant response time (minutes): 8.05
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Esther Cortez | Licensing Program Analyst | Conducted the complaint investigation visit and authored the report |
| Aleesha Zuniga | Health Services Director | Authorized to review and sign the report during the visit |
| John Washko | General Manager | Unable to be present during the visit but authorized report signing |
| Kasandra Lopez | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Complaint Investigation
Census: 72
Capacity: 100
Deficiencies: 0
Date: Mar 28, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations received on 2024-09-17 regarding staff not ensuring residents' care needs are met, transportation arrangements are provided, and residents are spoken to appropriately.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included staff not ensuring residents' care needs were met, not providing transportation arrangements, and not speaking to residents appropriately. Interviews and record reviews did not support these allegations.
Findings
The investigation found all allegations to be unsubstantiated based on interviews with residents and staff, and review of records. Residents' care needs were met, transportation arrangements were provided, and no inappropriate language by staff was witnessed. No deficiencies were observed.
Report Facts
Capacity: 100
Census: 72
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Teresa Camara | Licensing Program Analyst | Conducted the complaint investigation |
| Desaree Perera | Licensing Program Manager | Named in report as Licensing Program Manager |
| John Washko | Executive Director | Met with during investigation |
| Aleesha Zuniga | Health Services Director, LVN | Met with during investigation |
Inspection Report
Complaint Investigation
Census: 82
Capacity: 100
Deficiencies: 0
Date: Dec 30, 2024
Visit Reason
An unannounced complaint investigation visit was conducted in response to allegations that staff were not properly caring for residents, not checking on residents during the night, and that staff took away residents' medication.
Complaint Details
The complaint investigation was triggered by allegations that staff were not properly caring for residents, not checking on residents during the night, and taking away residents' medication. After interviews and file reviews, all allegations were deemed unsubstantiated.
Findings
The investigation found that the allegations were unsubstantiated. Interviews with residents, staff, and family members indicated that residents were checked frequently, including at night, and that staff provided adequate care. The allegation regarding medication was also unsubstantiated as medication management protocols were followed.
Report Facts
Capacity: 100
Census: 82
Number of residents interviewed: 3
Number of staff interviewed: 6
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Esther Cortez | Licensing Program Analyst | Conducted the complaint investigation |
| Kasandra Lopez | Licensing Program Manager | Named in report as Licensing Program Manager |
| J.P. Rollet | Acting Administrator | Met with Licensing Program Analyst during the investigation |
| John Washko | General Manager | Met with Licensing Program Analyst during the investigation |
Inspection Report
Complaint Investigation
Census: 83
Capacity: 100
Deficiencies: 0
Date: Jul 25, 2024
Visit Reason
The inspection was conducted as a follow-up on a self-reported incident received on 07/10/2024 regarding a stolen vehicle taken by a staff member.
Complaint Details
The complaint involved Resident #1 reporting a stolen vehicle taken by Staff #1. The investigation included interviews with the administrator and the resident, and review of pertinent documents.
Findings
No immediate health and safety concerns were observed during the inspection. The Licensing Program Analyst conducted interviews and a physical plant tour as part of the investigation.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jeanphilippe Rollet | Administrator | Met with Licensing Program Analyst during inspection and interviewed regarding the incident. |
| Emily Peraldi | Licensing Program Analyst | Conducted the unannounced Case Management - Incident inspection. |
| Lance Shenk | Administrator/Director | Listed as facility administrator/director. |
Inspection Report
Annual Inspection
Census: 79
Capacity: 100
Deficiencies: 1
Date: Jul 23, 2024
Visit Reason
The inspection was an unannounced required annual visit to evaluate compliance with Title 22 regulations and assess the facility's health, safety, and operational standards.
Findings
The facility was generally found to be in compliance with regulations, including proper maintenance of fire safety equipment, clean kitchen and common areas, adequate resident rooms and bathrooms, and proper medication management. However, one deficiency was cited related to a staff member lacking a transfer of criminal record clearance, posing an immediate risk.
Deficiencies (1)
One staff member did not have a transfer of criminal record clearance as required by CCR 87355(e)(3), posing an immediate health, safety, or personal rights risk to persons in care.
Report Facts
Civil penalty amount: 500
Resident rooms observed: 10
Resident bathrooms observed: 10
Water temperature range: 107.5-116.7
Resident files reviewed: 5
Staff files reviewed: 5
Medications reviewed: 5
Resident interviews conducted: 5
Staff interviews conducted: 5
Food supply duration: 7
Food supply duration: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jeanphilippe Rollet | Administrator | Met with LPAs during inspection and involved in facility tour and exit interview. |
| Aleesha Zuniga | Health Services Director | Met with LPAs during inspection. |
| Kelly Burley | Licensing Evaluator | Conducted the inspection and signed the report. |
| Jill Nakata | Supervisor | Supervisor overseeing the licensing evaluation. |
Inspection Report
Annual Inspection
Census: 84
Capacity: 100
Deficiencies: 1
Date: Jan 16, 2024
Visit Reason
An unannounced Annual Continuation Visit was conducted to continue the annual inspection visit initiated on 07/11/2023, including a medication audit and record review.
Findings
Deficiencies were found related to medication documentation, specifically expiration dates and start dates not properly documented for multiple medications during audits of two residents. Staff corrected the documentation upon observation.
Deficiencies (1)
Failure to comply with medication documentation requirements for centrally stored medications in two out of five resident medication audits, posing potential health, safety, or personal rights risks.
Report Facts
Residents audited: 2
Medications with undocumented expiration dates: 15
Medications with undocumented expiration dates: 9
Medications not documented on centrally stored log: 2
Plan of Correction due date: Jan 23, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lance Shenk | Administrator | Administrator present during the visit |
| Esther Cortez | Licensing Program Analyst | Conducted the inspection and medication audit |
| Kasandra Lopez | Licensing Program Manager | Supervisor and Licensing Program Manager named in report |
| Hannah Robertson | Business Office Manager | Greeted the Licensing Program Analyst and informed of visit reason |
Inspection Report
Annual Inspection
Census: 84
Capacity: 100
Deficiencies: 5
Date: Jul 11, 2023
Visit Reason
The inspection was an unannounced required annual visit to evaluate compliance with health and safety regulations and Title 22 requirements at the assisted living and memory care facility.
Findings
The facility was generally in compliance with regulations, including fire safety and infection control. However, deficiencies were noted including unlocked beauty salon with accessible chemicals posing immediate risk, incomplete staff training hours for some employees, and minor cleanliness issues in bathrooms and furniture condition.
Deficiencies (5)
Beauty salon was unlocked with chemicals and cleaning supplies accessible to residents, posing an immediate health and safety risk.
One out of five staff files reviewed had only 3.5 hours of initial training out of 40 required hours.
Unable to confirm required four hours of postural support and prohibited health training for two out of five staff files reviewed.
Two toilets required cleaning and one bathroom floor was unclean; staff cleaned upon observation.
Four chairs in memory care were in poor condition; new chairs ordered.
Report Facts
Capacity: 100
Census: 84
Staff files reviewed: 5
Resident files reviewed: 5
Resident interviews: 4
Staff interviews: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lance Shenk | Administrator | Named in relation to locking the beauty salon upon observation and during facility tour |
| Esther Cortez | Licensing Program Analyst | Conducted inspection and reviewed staff files |
| Ashley Smith | Licensing Program Analyst | Conducted inspection and reviewed resident files |
| Desaree Perera | Licensing Program Manager | Oversaw inspection and participated in facility tour |
Inspection Report
Complaint Investigation
Census: 81
Capacity: 100
Deficiencies: 0
Date: Feb 24, 2023
Visit Reason
The visit was conducted as a complaint investigation following an allegation that facility staff were not meeting the needs of a resident in care.
Complaint Details
The complaint alleged that staff were neglecting a resident who was observed hanging off the bed with a leaking cancer wound and other issues. The resident's physician report indicated the resident required extensive assistance but could communicate needs and feed self. Interviews and reviews showed staff were attentive and the resident's family had no concerns. The allegation was deemed unsubstantiated.
Findings
The investigation found the allegation unsubstantiated. Interviews with residents, staff, and the resident's family indicated that staff were responsive and providing appropriate care. No citations were issued.
Report Facts
Complaint Control Number: 29-AS-20220922164050
Capacity: 100
Census: 81
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Martha Arroyo | Licensing Program Analyst | Conducted the complaint investigation and visits |
| Desaree Perera | Licensing Program Manager | Named in report as Licensing Program Manager |
| Mary Sawyer | Marketing Director | Met with during the investigation as Executive Director was unavailable |
| Karen G Goroyan | Administrator | Facility Administrator named in report |
Inspection Report
Complaint Investigation
Census: 83
Capacity: 100
Deficiencies: 0
Date: Nov 17, 2022
Visit Reason
The inspection visit was conducted as an unannounced complaint investigation following a complaint received on 03/28/2022 regarding the facility's alleged failure to respond to residents' responsible persons' correspondence.
Complaint Details
The complaint alleged that the facility failed to respond to residents' responsible persons' correspondence. After interviews with facility staff and residents' responsible persons on multiple dates, the allegation was found unsubstantiated.
Findings
The investigation found insufficient evidence to support the allegation that the facility failed to respond to residents' responsible persons' correspondence. Therefore, the allegation was deemed unsubstantiated.
Report Facts
Complaint Control Number: 29-AS-20220328145922
Facility Capacity: 100
Census: 83
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Joann Rosales | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Lance Shenk | Executive Director | Met with Licensing Program Analyst during investigation and discussed the allegation |
Inspection Report
Complaint Investigation
Census: 83
Capacity: 100
Deficiencies: 0
Date: Oct 6, 2022
Visit Reason
The inspection was conducted as a complaint investigation following an allegation of neglect/lack of care and supervision resulting in resident #1 falling and sustaining a fractured wrist.
Complaint Details
The complaint alleged neglect/lack of care and supervision causing resident #1 to fall and sustain a fractured wrist. After interviews, document reviews, and medical record analysis, no neglect or lack of supervision was observed or supported by evidence. The allegation was unsubstantiated.
Findings
The investigation found that resident #1 had two falls, one witnessed and one unwitnessed, resulting in injuries including a fractured wrist and brain bleed. The facility staff denied neglect and reported adequate staffing levels. The evidence did not support the allegation, and the complaint was deemed unsubstantiated.
Report Facts
Facility capacity: 100
Resident census: 83
Dates of falls: Resident #1 had a witnessed fall on 2021-12-12 and an unwitnessed fall on 2022-03-06
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lance Shenk | Administrator | Met during investigation and interviewed regarding complaint |
| Kelly Dulek | Licensing Program Analyst | Conducted complaint investigation and authored report |
| Hannah Robertson | Business Office Manager | Met during investigation and interviewed |
| Mark Brassfield | Health Services Director | Met during investigation and interviewed |
| Douglas Real | Investigator | Conducted interviews and reviewed records during investigation |
| Angel Ascencio | Licensing Program Analyst | Conducted unannounced complaint visit and entrance interview |
| Kristin Heffernan | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 77
Capacity: 100
Deficiencies: 0
Date: Jun 22, 2022
Visit Reason
The visit was an unannounced complaint investigation conducted to investigate allegations of lack of supervision resulting in resident eloping from the facility and failure to report the elopement incident.
Complaint Details
The complaint investigation was triggered by allegations of lack of supervision resulting in resident eloping and failure to report the elopement incident. The allegations were found to be unfounded.
Findings
The investigation found that Resident #1 resides in the Assisted Living section and is able to leave the facility unassisted. Records and interviews confirmed the resident is self-responsible and able to leave the facility unassisted. The allegations were deemed unfounded.
Report Facts
Capacity: 100
Census: 77
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Zabel Chochian | Licensing Program Analyst | Conducted the complaint investigation visit |
| Karen G. Goroyan | Executive Director/Administrator | Met with Licensing Program Analyst during investigation |
| Mark Brassfield | Health Service Director | Met with Licensing Program Analyst during investigation |
Inspection Report
Annual Inspection
Census: 75
Capacity: 100
Deficiencies: 3
Date: Jun 13, 2022
Visit Reason
An unannounced Required - 1 Year inspection was conducted to evaluate the facility's compliance with regulations including infection control, safety, and medication storage.
Findings
The inspection found several deficiencies related to unsecured medication carts, accessible scissors in the activities director's office, and toxic substances accessible to residents with dementia, all posing immediate health and safety risks. The facility took corrective actions during the visit and planned staff training.
Deficiencies (3)
Unsecured medication cart in the Creekside memory care activity room accessible to residents.
Scissors observed in an unlocked activities director's office accessible to residents.
Toxic substances accessible to residents with dementia.
Report Facts
Deficiencies cited: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Karen Gary Goroyan | Administrator | Met with Licensing Program Analyst during inspection and involved in corrective actions. |
| Mark Brassfield | Staff present during inspection when unsecured scissors and personal care items were observed. | |
| Joann Rosales | Licensing Program Analyst | Conducted the inspection and authored the report. |
| Kristin Heffernan | Licensing Program Manager | Supervisor overseeing the inspection. |
Inspection Report
Original Licensing
Census: 69
Capacity: 100
Deficiencies: 1
Date: Jul 2, 2021
Visit Reason
Pre-licensing visit conducted as part of a change of ownership application from Aegis of Ventura #565800683, including inspection of fire safety, personal accommodations, medication procedures, and food service.
Findings
The facility was inspected and found to have adequate supplies, proper fire safety equipment, and appropriate accommodations including private bathrooms and approved bedridden rooms. However, the physical plant was not in compliance with Title 22 regulations at the time of inspection, with some medications and cleaning supplies accessible to residents.
Deficiencies (1)
Physical plant is not in compliance with Title 22 regulations at this time.
Report Facts
Capacity: 100
Census: 69
Hot water temperature readings: 112.1
Hot water temperature readings: 108.4
Hot water temperature readings: 112.9
Hot water temperature readings: 109.6
Number of bedridden residents approved: 18
Number of bedridden rooms: 18
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Sam El-Rabaa | Administrator | Administrator present during pre-licensing visit and named as applicant representative |
| JoAnn Rosales | Licensing Program Analyst | Conducted the pre-licensing visit and inspection |
| Ana De La Cerda | VP Regulatory Affairs | Applicant who designated the Administrator as applicant representative |
| Kristin Heffernan | Licensing Program Manager | Named in report header and footer |
Inspection Report
Original Licensing
Capacity: 100
Deficiencies: 0
Date: May 7, 2021
Visit Reason
The visit was conducted as part of the original licensing process involving a telephone call with the Community Care Licensing analyst to complete Component II of the application process and verify the applicant and administrator's understanding of Title 22 regulations.
Findings
The applicant and administrator successfully completed Component II, demonstrating understanding of facility operation, staff qualifications, program policies, grievance procedures, physical plant, and application document requirements. They were advised to submit required documentation including signed LIC 809 and photo ID.
Report Facts
Capacity: 100
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Sam El-Rabaa | Administrator | Named as facility administrator participating in licensing process |
| Ana De La Cerda | Met with during the visit | |
| Julia Kim | Licensing Program Manager | Named in report header |
| Nicole Rouse | Licensing Program Analyst | Named in report header and analyst conducting the licensing call |
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