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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565802453
Report Date: 03/25/2026
Date Signed: 03/26/2026 09:05:41 AM

Substantiated


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
03/20/2026 and conducted by Evaluator Valeria Conway
COMPLAINT CONTROL NUMBER: 29-AS-20260320140734
FACILITY NAME:AT HOME CAMARILLOFACILITY NUMBER:
565802453
ADMINISTRATOR:COLON, MARGARITAFACILITY TYPE:
740
ADDRESS:417 GARDENIA AVETELEPHONE:
(805) 383-8893
CITY:CAMARILLOSTATE: CAZIP CODE:
93010
CAPACITY:6CENSUS: 2DATE:
03/25/2026
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Celso EspirituTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Facility administrator is not present at the facility an adequate number of hours
Facility was understaffed during a medical emergency
INVESTIGATION FINDINGS:
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At 10:45 A.M. Licensing Program Analyst (LPA) Valeria Conway conducted an unannounced 10-day initial complaint visit to investigate the allegation listed above. The LPA was greeted by caregiver Celso Espiritu. At approximately 11:20 A.M. LPA Conway contacted the Administrator by phone, Margarita Colon. Administrator was unavailable during today's visit, but authorized Celso Espiritu to sign today's report. Entrance interview conducted.

During today’s visit from LPA and caregiver toured the physical plant to ensure there are no health and safety concerns, and the facility is in compliance with Title 22 regulation. Additionally, LPA conducted interviews with staff, residents, and visitors and reviewed and obtained pertinent documents relevant to the investigation. The following was then determined:

Continued on LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2026
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 6
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
03/20/2026 and conducted by Evaluator Valeria Conway
COMPLAINT CONTROL NUMBER: 29-AS-20260320140734

FACILITY NAME:AT HOME CAMARILLOFACILITY NUMBER:
565802453
ADMINISTRATOR:COLON, MARGARITAFACILITY TYPE:
740
ADDRESS:417 GARDENIA AVETELEPHONE:
(805) 383-8893
CITY:CAMARILLOSTATE: CAZIP CODE:
93010
CAPACITY:6CENSUS: 2DATE:
03/25/2026
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Celso EspirituTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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9
Uncleared staff worked at facility
INVESTIGATION FINDINGS:
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13
At 10:45 A.M. Licensing Program Analyst (LPA) Valeria Conway conducted an unannounced 10-day initial complaint visit to investigate the allegation listed above. The LPA was greeted by caregiver Celso Espiritu. At approximately 11:20 A.M. LPA Conway contacted the Administrator by phone, Margarita Colon. Administrator was unavailable during today's visit, but authorized Celso Espiritu to sign today's report. Entrance interview conducted.

During today’s visit from LPA and caregiver toured the physical plant to ensure there are no health and safety concerns, and the facility is in compliance with Title 22 regulation. Additionally, LPA conducted interviews with staff, residents, and visitors and reviewed and obtained pertinent documents relevant to the investigation. The following was then determined:

Continued on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 29-AS-20260320140734
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: AT HOME CAMARILLO
FACILITY NUMBER: 565802453
VISIT DATE: 03/25/2026
NARRATIVE
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Continued from LIC 9099


Regarding allegation of “Uncleared staff worked at facility” it was reported that Individual #1 was conducting repairs inside and outside of the facility despite not being an employee and lacking clearance or association with the facility. Interviews conducted revealed that I1, who is a relative of the administrator, was present at the facility to perform random maintenance work. I1 was present only during normal waking hours for a limited duration and did not provide care or supervision to residents in care. Based on the information gathered during the investigation, the allegation of “Uncleared staff worked at facility” is deemed UNSUBSTANTIATED, as there is insufficient evidence to support that I1 was working in a staff capacity.

No citations issued. Exit interview conducted. A copy of the report was provided.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 29-AS-20260320140734
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: AT HOME CAMARILLO
FACILITY NUMBER: 565802453
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/25/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/31/2026
Section Cited
CCR
87405(a)
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87405 (a) All facilities shall have a qualified and currently certified administrator...shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility...by written documentation.
This requirement is not met as evidenced by:
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The Administrator will submit a plan of action as to how the facility will come into complance by POC due date.
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Based on observation and interview, the Administrator has not been present in the facility on their scheduled days for several weeks which poses a potential health and safety risk to persons in care.
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Type B
03/31/2026
Section Cited
CCR
87411(a)
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87411 Personnel Requirements General
(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs.
This requirement is not met as evidenced by:
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The Administrator agreed to adjust caregiver schedule and to have OnCall caregiver close by the facility available in case on emergencys. A statement of understanding on this regukation is required before POC due date.
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Based on interview and record review, the licensee did not comply with the above cited section, as there are no ON CALL caregivers readily available in case of an emergency, which poses an potential safety risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 29-AS-20260320140734
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: AT HOME CAMARILLO
FACILITY NUMBER: 565802453
VISIT DATE: 03/25/2026
NARRATIVE
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Continued from LIC 9099

Regarding allegation “Facility administrator is not present at the facility an adequate number of hours” It was reported that the Administrator does not regularly visit the facility due to distance, and is present approximately once a week and at times not at all during certain weeks. At approximately 11:20 A.M. a phone interview with the Administrator revealed that they were attending a meeting and were unable to arrive at the facility prior to 4:00 P.M. The LPA reviewed the LIC 500 Personnel Report, which indicates that the Administrator is scheduled as “on call” and assigned to work seven (7) days a week during evening hours from 07:00 P.M. to 07:00 A.M. However, the Administrator was not present on today's visit, the prior annual visit conducted on 01/23/2026, or during the reported scheduled hours. Interviews further revealed that the Administrator was last physically present at the facility several weeks ago, and it was also indicated that the Administrator’s presence at the facility was inconsistent. Additionally, it was reported that the Administrator’s primary residence is in Temecula, CA. Based on the information gathered during the investigation, the department has sufficient evidence to confirm this allegation occurred. Therefore, the allegation of “Facility administrator is not present at the facility an adequate number of hours” has been SUBSTANTIATED at this time.

Regarding allegation “Facility was understaffed during a medical emergency” it was reported that a recent incident occurred in which the sole caregiver on duty experienced a medical emergency and was transported to the hospital. The Reporting Party expressed concern that, due to the Administrator residing hours away, individuals who were not scheduled employees temporarily provided care and supervision to residents until the Administrator arrived several hours later. An interview with the Administrator confirmed that on the day of the incident, Staff #1 (S1) experienced a medical emergency and was transported to the hospital. However, the Administrator requested help from a Family Member (FM) to provide temporary supervision until their arrival and that a visitor also remained at the facility for approximately 30 minutes to assist. The LPA reviewed the Guardian System and revealed that FM is fingerprinted cleared and associated to the facility. The Administrator further stated that the facility currently employs two (2) caregivers who work alternating live-in schedules for consecutive days. At the time of the incident, the relieving caregiver was unavailable due to being out of the area. Interviews with staff indicated that the current residents are generally easy to care for and do not require extensive assistance.



Continued on LIC 9099-C
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 29-AS-20260320140734
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: AT HOME CAMARILLO
FACILITY NUMBER: 565802453
VISIT DATE: 03/25/2026
NARRATIVE
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Continued from LIC 9099-C

However, additional interviews revealed that when only one (1) caregiver is on duty, residents may experience delays in receiving assistance when the caregiver is occupied with other tasks. It was also reported that residents are sometimes instructed to wait for assistance while the caregiver completes chores or assists another resident. During the visit, the LPA observed that while the sole caregiver assisted one resident with bathing and grooming for approximately 45 minutes, the other resident remained alone in the living room without supervision. Based on the information gathered during the investigation, the department has sufficient evidence to confirm this allegation occurred. Therefore, the allegation of “Facility was understaffed during a medical emergency” has been SUBSTANTIATED at this time.

Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiency was cited (refer to LIC 9099-D.) Facility Designee was informed that failure to correct the deficiency may result in civil penalties.

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

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

DATE: 03/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2026
LIC9099 (FAS) - (06/04)
Page: 6 of 6