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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850142
Report Date: 11/26/2024
Date Signed: 11/26/2024 10:07:26 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
11/28/2023 and conducted by Evaluator Kelly Dulek
COMPLAINT CONTROL NUMBER: 29-AS-20231128101329
FACILITY NAME:CAMARILLO SENIOR LIVINGFACILITY NUMBER:
565850142
ADMINISTRATOR:GENA GRUNDEISFACILITY TYPE:
741
ADDRESS:6000 SANTA ROSA ROADTELEPHONE:
(805) 388-8086
CITY:CAMARILLOSTATE: CAZIP CODE:
93012
CAPACITY:140CENSUS: 86DATE:
11/26/2024
UNANNOUNCEDTIME BEGAN:
09:08 AM
MET WITH:Marjorie Manning, Resident Care DirectorTIME COMPLETED:
10:15 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff handled resident roughly resulting in injury
Staff do not ensure resident hygiene needs are met
Staff do not treat resident(s) with dignity and respect
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Kelly Dulek conducted a subsequent complaint investigation with the purpose of delivering findings for the allegations listed above. LPA arrived at the facility at 09:08AM and was greeted by front desk staff. LPA was informed Pending Administrator Scott Keawekane was unavailable during today’s visit. LPA met with Resident Care Director Marjorie Manning. Entrance interview conducted.

During today’s visit, LPA interviewed Resident #1 (R1) at 09:25AM. During an initial visit conducted on 11/29/2023, LPA toured the facility with Health and Wellness Director at 01:48PM, interviewed Health and Wellness Director at 02:08PM, and LPA reviewed and received copies of documents pertinent to the investigation. No immediate health and safety concerns were observed during facility tour. During a subsequent complaint visit conducted on 11/05/2024, LPA toured the facility with pending Administrator at 11:35AM and LPA interviewed staff and residents between 10:35AM to 02:00PM. Throughout the course of the investigation, LPA reviewed all pertinent documents. The following was then determined:
Report Continued on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024
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-20231128101329
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: CAMARILLO SENIOR LIVING
FACILITY NUMBER: 565850142
VISIT DATE: 11/26/2024
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
Allegation: Staff handled resident roughly resulting in injury:

The complaint alleges that Staff #1 (S1) was observed being rough with residents, resulting in bruising to Resident #1 (R1)’s leg. Throughout the investigation, LPA interviewed various staff and residents, including S1, LPA observed R1 during the initial visit, and interviewed R1 during today's visit. LPA did not observe bruising on R1’s leg during the initial visit. Residents interviewed, including R1, indicated care staff is helpful and all residents interviewed denied the allegation. One resident interviewed did indicate staff rush when providing care, but clarified staff are not rough, just quicker than the resident prefers. Staff interviewed indicated they have never witnessed another staff nor have they heard from any residents that staff were rough. Staff also stated that any bruising or unusual marks observed are reported on a skin check form. R1 did not have any observed injuries at the time period of the complaint, therefore did not have any skin check forms to review. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation “staff handled resident roughly resulting in injury” is deemed UNSUBSTANTIATED at this time.

Allegation: Staff do not ensure resident hygiene needs are met:

The complaint alleges that S1 does not encourage residents to shower and communicates to direct residents to deny shower assistance. Staff interviewed indicate that most residents receive shower assistance twice a week, which is documented in their shower schedule. If a resident declines a shower at a specific day or time, the staff will offer a sponge bath instead of a full shower or they will offer the shower at a different time. Shower refusals are documented and when a resident does refuse showers, the facility staff will communicate with the resident’s family. Staff indicated there are some residents who do not want to shower at a particular time, especially in the morning in the fall when the weather is cooler. But typically, the facility staff is able to provide a shower later in the day when the weather warms up. No staff interviewed reported ever witnessing this type of communication and said if anything, the facility staff are observed to be too accommodating. Residents interviewed felt their showering needs are met and had no concerns with the staff communication related to showering. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation “staff do not ensure resident hygiene needs are met” is deemed UNSUBSTANTIATED at this time.

Report Continued on LIC 9099-C

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20231128101329
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: CAMARILLO SENIOR LIVING
FACILITY NUMBER: 565850142
VISIT DATE: 11/26/2024
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
Allegation: Staff do not treat resident(s) with dignity and respect:

The complainant indicates that S1 is disrespectful in their communication with residents. LPA interviewed staff and residents, including R1, related to this allegation. Residents interviewed indicated that the staff are kind and helpful. One resident stated that the staff does not like her cat, but that they are nice to the resident. No residents reported any concerns with the staff being disrespectful or not treating them with dignity. Staff interviews revealed sometimes residents don’t like if the staff leave the door to their room open or cracked open, but no concerns about staff being disrespectful. All staff interviewed denied ever hearing any other staff not treating residents with respect. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation “staff do not treat resident with dignity and respect” is deemed UNSUBSTANTIATED at this time.

No citations issued. Exit interview conducted. A copy of the report was provided.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3