565800682-10-15-2024-29-AS-DPEA-DAGV96-20241028161349

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565800682
Report Date: 10/15/2024
Date Signed: 10/15/2024 03:38:04 PM

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
09/30/2024 and conducted by Evaluator Valeria Conway

COMPLAINT CONTROL NUMBER: 29-AS-20240930113535

FACILITY NAME:	ALMAVIA OF CAMARILLO		FACILITY NUMBER:	565800682
ADMINISTRATOR:	MICHAEL O'NEILL		FACILITY TYPE:	740
ADDRESS:	2500 NORTH PONDEROSA DRIVE		TELEPHONE:	(805) 388-5277
CITY:	CAMARILLO	STATE: CA	ZIP CODE:	93010
CAPACITY:	100	CENSUS: 57	DATE:	10/15/2024
		UNANNOUNCED	TIME BEGAN:	12:32 PM
MET WITH:	Michael O'Neill		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff hit resident(s)

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA), Valeria Conway conducted a subsequent complaint visit to the above facility. The purpose of the visit is to deliver findings for the above allegation. Upon arrival, LPA met with Administrator, Michael O’Neill, and the reason for the visit was explained. Entrance interview conducted.
It was alleged that staff hit residents.

The Reporting Party (RP) further stated that on 09/17/2024, Staff #1 (S1) swatted Resident #1 (R1) twice on R1s wrist while assisting R1 from the toilet to the wheelchair and that REsident #2 (R2) was swatted on the butt cheek after changing their diaper.

Continued on LI 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024

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 3

Control Number 29-AS-20240930113535

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: ALMAVIA OF CAMARILLO	FACILITY NUMBER: 565800682
	VISIT DATE: 10/15/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Continued from LIC 9099

On 09/27/2024, a Case Management – Incident visit was conducted by LPA Conway to follow up on two (2) separate self-reported Incident Reports (SIRs) submitted to the Department by the facility. It was reported that on 09/17/2024, S1 was observed swatting the wrist of R1 twice while assisting R1 from the toilet to the wheelchair. In a separate incident, S1 was observed swatting Resident #2 (R2) on the butt cheek after changing their diaper. During the visit, LPA Conway along with staff conducted a plant tour to ensure there were no health and safety concerns, conducted an interview with the Administrator at 12:00 P.M., conducted a resident file review starting at 1:15 P.M., and obtained copies of pertinent documents.

On 10/02/2024, LPA Conway conducted an initial 10-day complaint visit. During the visit, LPA conducted interviews with two (2) staff members and attempted to interview S3. LPA was unable to get S3 statement During the visit, LPA was informed that Ventura County Sheriffs (VCS) office responded to the facility on 09/23/2024 to investigate the incidents. On 10/04/2024, LPA obtained and reviewed police reports received from VCS.
Information gathered during the course of the investigation revealed that on 09/17/2024, S2 was being trained by S1. During that day, S2 observed S1 swatting two (2) dementia residents. S2 reported both incidents to Resident Care Director (RCD) on 09/22/2024. Facility self-reported these two (2) separate incidents to Community Care Licensing (CCL) on 09/23/2024. Both incidents identified S1 as the alleged aggressor. No injuries were noted on R1 or R2. R1 and R2 responsible parties were contacted.

A review of the records and interviews conducted revealed that facility has a camera system in the memory care common areas. No cameras are installed inside residents’ rooms. On 09/17/2024, video recordings shows that three (3) staff members were inside R2’s room. S2 was the only eyewitness to come forward about these incidents. Administrator provided written statement by S2 to LPA. On 09/24/2024, LPA interviewed S1. S1 denied hitting residents and explained that caregiving is their passion and that they would never put hands on any residents. However, S3 provided a statement to facility’s Administrator and denies being in R2’s room with S1 and S2 during the incident.

Continued on LIC 9099-C

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 29-AS-20240930113535

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: ALMAVIA OF CAMARILLO	FACILITY NUMBER: 565800682
	VISIT DATE: 10/15/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Continued from LIC 9099-C

Further record review and interviews conducted revealed that facility’s Administrator and Human Resources staff conducted an internal investigation, including reviewing of video footage and interviews to caregivers. On the recording shows that S1, S2 and S3 entering and exiting R2’s room. No recording on allegations were captured.

Review of police report revealed that local police responded to a called by facility’s Administrator on 09/23/2024 regarding a possible elder abuse incident. During police investigation, officer conducted interviews with Administrator and staff members. Due to lack of evidence, injuries and information during interviews conducted, officer did not believe that the crime of elder abuse took place during either incident. Based on the information gathered during the course of the investigation, the Department does not have sufficient evidence to determine that S1 swatted R1 and R2. Although the allegations may have happened or is valid, there is insufficient evidence to prove the alleged violation occurred, therefore this allegation is deemed Unsubstantiated at this time.

No citations issued at this time. Exit interview conducted. Report was reviewed and a copy was issued.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 3