<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565800682
Report Date: 11/13/2025
Date Signed: 11/13/2025 05:32:38 PM

Document Has Been Signed on 11/13/2025 05:32 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: 56DATE:
11/13/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Michael ONeilTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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
Licensing Program Analysts (LPA)s Valeria Conway and Martha Arroyo arrived at the facility at 9:30 A.M., for an unannounced annual inspection. Upon arrival, LPAs met with Administrator Michael O’Neill and explained the reason for the visit. Entrance interview conducted.

Beginning at 10:28 A.M., the LPAs along with Administrator 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, with an annual fire alarm test and inspection record conducted on 06/03/2025. As of today, all deficiencies have been cleared. Fire extinguishers throughout the building were observed to be fully charged and last serviced on 08/20/2025. At 11:54 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 4 (four) 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 slip-resistant flooring. Hot water temperature was measured in four (4) bathrooms. All four (4) bathrooms inspected in the Assisted Living unit measured above the required range of 105 to 120 degrees Fahrenheit.

Continued on LIC 809-C

NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Valeria Conway
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/13/2025
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 5
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
Page: 2 of 5
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: 11/13/2025
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 809

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 sample of four (4) resident rooms were observed to be furnished appropriately. Bathrooms were observed to be safe and sanitary with grab bars and slip-resistant flooring. Hot water temperature was measured in four (4) bathrooms. Two (2) out of four (4) bathrooms inspected in the Memory Care unit measured above 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 toured the outside areas of the facility. The Assisted Living and Memory Care unit 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. The LPAs observed the stairwells and they each had an emergency evacuation chair. Activity Rooms were observed clean at the time of visit.

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

NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Valeria Conway
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2025
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 11/13/2025 05:32 PM - It Cannot Be Edited


Created By: Valeria Conway On 11/13/2025 at 03:34 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: ALMAVIA OF CAMARILLO
FACILITY NUMBER: 565800682

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/13/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87303(e)(3)
Maintenance and Operation
(e) Water supplies and plumbing fixtures shall be maintained as follows: (3) Taps delivering water at 125 degree F (52 degrees C) or above shall be prominently identified by warning signs.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above by having the hot water temperature above the required range which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 11/13/2025
Plan of Correction
1
2
3
4
The administrator requested maintenance personnel to adjust the hot water temperature to ensure it remained within the required range of 105-120 degree F.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Desaree Perera
NAME OF LICENSING PROGRAM MANAGER:
Valeria Conway
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 11/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/13/2025


LIC809 (FAS) - (06/04)
Page: 4 of 5
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: 11/13/2025
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 809-C

RECORD REVIEW: Between 12:00 P.M and 1:14 P.M., LPAs reviewed six (6) staff files and six (6) 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 2:40 P.M. LPAs observed medications for six (six) residents. All medications observed were stored and recorded in compliance with regulation.

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 10/10/2025. During today’s visit LPAs obtained a copy of the facility’s LIC 500, resident roster, last emergency drill and current liability insurance.

Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 809-D.) Administrator was informed that failure to correct the deficiencies may result in civil penalties.

Exit interview conducted, appeal rights discussed, and a copy of this report and appeal rights were provided.

NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Valeria Conway
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2025
LIC809 (FAS) - (06/04)
Page: 5 of 5