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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850142
Report Date: 09/12/2025
Date Signed: 09/12/2025 01:12:10 PM

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
09/05/2025 and conducted by Evaluator Martha Arroyo
COMPLAINT CONTROL NUMBER: 29-AS-20250905153606
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: 101DATE:
09/12/2025
UNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Marjorie Manning - Health Wellness DirectorTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Facility staff are forcing resident to stay in their room alone
Facility staff are not allowing resident to leave facility premises with responsible person
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Martha Arroyo conducted an initial complaint investigation visit for the above allegations. Upon arrival, the LPA met with Health & Wellness Director, Marjorie Manning and explained the reason for the visit. The Executive Director, Scott Keawekane was unavailable during today's visit. Entrance interview.

During today's visit, between 09:52 a.m. and 11:30 a.m., the LPA conducted a plant tour, observed the memory care unit, conducted interviews with three staff, two residents, attempted to interview Resident #1 (R1), and conducted a resident file review and obtained copies of pertinent documents relevant to the investigation.

Report Continued on LIC 9099C…
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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Control Number 29-AS-20250905153606
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: 09/12/2025
NARRATIVE
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Report Continued from LIC 9099…

It was alleged that facility staff are forcing resident to stay in their room alone. It was reported that R1 is being forced to stay inside their bedroom alone all day, and that staff redirect R1 back into the bedroom when R1 attempts to leave. Record review and interviews conducted revealed that R1 tested positive for COVID-19 on 09/05/2025. Staff stated they were instructed to follow public health guidelines, which include self-isolation for ten (10) days following a positive test, as well as wearing masks when around others. The facility has been conducting COVID-19 testing twice a week, with the last test being completed on 09/11/2025. However, staff reported that R1 refused to take the COVID-19 test on that date and has also refused testing today. Staff further added that R1 is allowed to leave their bedroom but is encouraged to wear a mask to help protect the other residents. Staff also noted that R1 is allowed to spend time outside in the garden when other residents are not present, as R1 does not like wearing a mask. Interviews conducted with other residents indicated that they have not witnessed staff forcing residents back into their rooms and stated that they are able to go anywhere they choose. During today’s visit, the LPA observed R1 walking in the hallway without a mask. Although staff encouraged R1 to wear one, the LPA did not observe staff forcing the resident to return to their bedroom or requiring them to wear a mask. Based on the information obtained and reviewed, the Department has insufficient evidence to support the allegation of “facility staff are forcing resident to stay in their room alone”. Therefore, this allegation is deemed Unsubstantiated at this time.

It was also alleged that facility staff are not allowing resident to leave facility premises with responsible person. It was reported that although R1 is allowed to have visitors and spend time in the courtyard, they are not allowed to participate in outings away from the facility unless the outing is strictly for medical appointments. Interviews with staff revealed that R1’s responsible person had inquired about taking R1 to a movie theater. Staff stated that the responsible person was strongly encouraged not to take R1 to public places, as R1 is unable to tolerate wearing a face mask for more than five (5) minutes at a time. Staff further explained that R1’s responsible person was advised that outings should be limited to essential medical appointments due to the potential health risk. Furthermore, although staff discouraged non-essential outings over concerns that R1 might still be contagious and pose a risk to the public, they acknowledged that it is ultimately R1’s responsible person final decision. Based on the information obtained and reviewed, the Department has insufficient evidence to support the allegation of “facility staff are not allowing resident to leave facility premises with responsible person”. Therefore, this allegation is deemed Unsubstantiated at this time.

Exit interview conducted. A copy of the report was issued.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2025
LIC9099 (FAS) - (06/04)
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