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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565800682
Report Date: 09/27/2024
Date Signed: 10/01/2024 08:14:38 AM

Document Has Been Signed on 10/01/2024 08:14 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:ALMAVIA OF CAMARILLOFACILITY NUMBER:
565800682
ADMINISTRATOR/
DIRECTOR:		MICHAEL O'NEILLFACILITY TYPE:
740
ADDRESS:2500 NORTH PONDEROSA DRIVETELEPHONE:
(805) 388-5277
CITY:CAMARILLOSTATE: CAZIP CODE:
93010
CAPACITY: 100CENSUS: 77DATE:
09/27/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:50 AM
MET WITH:Michael O'NeillTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Valeria Conway conducted an unannounced Case Management – Incident visit at 11:50 A.M. for the purpose of investigating self-reported incident reports. Upon arrival, LPA met with Executive Director (ED), Michael O’Niell, and explained the reason for the visit. Entrance interview conducted.

The purpose of today's inspection is to follow up on two (2) self-reported incident reports that were submitted to the Woodland Hills Regional Office late on 09/23/2024. According to the reports, on 09/22/2024, Staff #1 (S1) reported to Staff #2 (S2) that they witnessed Staff #3 (S3) swatting Resident #1 (R1) on their wrist while transferring them from the toilet to their wheelchair. Additionally, it was also reported that S3 allegedly swatted Resident #2 (R2) on the bottom while assisting with a diaper change.

During today's visit, the LPA toured the facility with ED, conducted interviews and gathered copies of pertinent documents and police report number. ED stated that police report is expected to be delivered in a few days. No immediate health and safety concerns were noted during today's facility tour.

Further investigation is required at this time. An additional report may follow, if warranted.



Exit interview conducted. A copy of the report was provided.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2024
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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