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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565800682
Report Date: 11/05/2024
Date Signed: 11/05/2024 03:16:26 PM

Document Has Been Signed on 11/05/2024 03:16 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
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: 55DATE:
11/05/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Sarah StichlerTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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Licensing Program Analysts (LPA)s Valeria Conway and Martha Arroyo arrived at the facility at 9:00 A.M., for an unannounced annual inspection. Upon arrival, LPAs met with Business Office Manager, Sarah Stichler and Resident Care Director, Erika Miller. Administrator Michael O’Neill was unable to be present during today’s visit and authorized Business Office Manager to review and sign the report. Entrance interview conducted.

Beginning at 9:15 A.M., the LPAs along with both staff, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed:

5-Year fire sprinkler inspection was completed on 09/15/2023. No safety concerns were noted at that time. Fire extinguishers throughout the building were observed to be fully charged and last serviced on 08/30/2024. At 9:58 A.M., carbon monoxide alarm was tested and properly functioned at the time of the visit.

ASSISTING LIVING ROOMS: There are 60 Assisted Living units and can be found on the first and second floors of the building. Assisted Living units are equipped with a refrigerator, sink, and microwave and contain private restrooms. A random selection of 6 (six) resident rooms were observed. Residents’ rooms were observed to be furnished appropriately and contained appropriate bedding/linens. Bathrooms were observed to be safe and sanitary with grab bars and non-skid mats. Hot water temperature was checked in multiple randomly selected rooms in the Assisted Living unit and measured within the required range of 105 to 120 degrees Fahrenheit.

Continued on LIC 809

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE: DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/05/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 11/05/2024
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Continued from LIC 809-C

MEMORY CARE ROOMS: Memory Care is located on the first floor and has 18 (eighteen) rooms. Resident bedrooms are single and double occupancy with private bathrooms. A random sampling of 2 (two) resident rooms were observed to be furnished appropriately. Bathrooms were observed to be safe and sanitary with grab bars and non-skid mats. Hot water was measured in a sample of observed resident rooms and tested within the required range of 105 to 120 degrees Fahrenheit. Medications for the memory care unit are centrally stored and locked in the medication room. The indoor and outdoor areas of the memory unit are secured with a delayed egress system, which functioned properly during the visit. There are two outdoor gated courtyards designated for Memory Care.

COMMON AREAS: The facility is a two story building. The facility contains multiple common areas, which were all observed to be clean, furnished appropriately and in good condition at the time of the visit. There were no obstructions and/or tripping hazards throughout the facility. All required postings were observed in the common areas on the first floor. The LPAs and staff toured the outside areas of the facility. The Assisted Living and Memory Care, contained 2 (two) courtyards for resident use. During today’s visit the LPAs observed two operational water fountains, one the promises. One fountain is located in the assisted living area and the other is situated withing the memory care unit. The LPAs observed appropriate outdoor furniture, with a covered shaded area for resident use. The facility maintained a comfortable temperature of 73 degrees. LPAs observed cameras throughout the common areas only. Facility provides sufficient space to accommodate both indoor and outdoor activities. Several fireplaces were observed throughout the facility adequately screened.

KITCHEN: The main kitchen and dining room are located on the 1st floor. Food is prepared in the main kitchen and delivered to the dining area and the Memory Care dining room. Facility dining room and commercial kitchen were inspected and found to be in compliance with Title 22 regulations. LPAs observed a minimum of two (2) days perishable and seven (7) days non-perishable foods. LPAs inspected refrigerator and pantry for expiration dates. LPAs observed a sufficient supply of emergency food and water.

Continued on LIC 809-C

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 11/05/2024
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Continued from LIC 809-C

LPAs also reviewed the facility's Emergency Disaster Plan, which was observed to be complete and updated annually as required. Emergency Disaster drills are conducted monthly, with the last drill documented on 10/28/2024. During today’s visit LPAs obtained a copy of the facility’s LIC 500, resident roster and last emergency drill.

RECORD REVIEW: Between 11:38 A.M and 1:14 P.M., LPAs reviewed 7 (seven) staff files and 7 (seven) 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 1:50 P.M. LPAs observed medications for 7 (seven) residents. All medications observed were stored and recorded in compliance with regulation.

INTERVIEWS: Throughout today's visit, LPAs interviewed 5 (five) residents and 4 (four) staff members.

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

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024
LIC809 (FAS) - (06/04)
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