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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565800682
Report Date: 05/01/2024
Date Signed: 05/01/2024 03:24:29 PM

Document Has Been Signed on 05/01/2024 03:24 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:ALMAVIA OF CAMARILLOFACILITY NUMBER:
565800682
ADMINISTRATOR/
DIRECTOR:		JUSTINE ORTIZFACILITY TYPE:
740
ADDRESS:2500 NORTH PONDEROSA DRIVETELEPHONE:
(805) 388-5277
CITY:CAMARILLOSTATE: CAZIP CODE:
93010
CAPACITY: 100CENSUS: 55DATE:
05/01/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:50 PM
MET WITH:Mike O'Neill, Executive DirectorTIME VISIT/
INSPECTION COMPLETED:
03:25 PM
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Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility at 12:50PM for an unannounced annual continuation visit. Upon arrival, LPA was greeted by front desk staff. Shortly after arrival, LPA met with Executive Director (ED) Mike O'Neill. Entrance interview conducted.

As a full facility tour was conducted during the initial annual inspection, during today's visit, LPA along with ED conducted a brief physical plant tour beginning at 01:29PM. The following was observed during today's visit:

RECORD REVIEW: LPA reviewed 5 (five) staff files and 5 (five) resident files. Files were reviewed for, but not limited to: Physician's Reports, Personal Rights, Admission Agreements, staff training records, health screenings, TB tests, and background clearance. All files reviewed were observed to be in compliance with regulation.

MEDICATIONS: Medication review began at 02:39PM. LPA observed medications for 3 (three) residents. All medications observed were stored and recorded in compliance with regulation.

No citations issued. Exit interview conducted. A copy of today's report was provided.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE: DATE: 05/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/01/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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