565850142-9-24-2026-29-AS-DPEA-DYENG4-20260930102631

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565850142
Report Date: 09/24/2026
Date Signed: 09/24/2026 03:43:25 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
05/12/2026 and conducted by Evaluator Martha Arroyo

COMPLAINT CONTROL NUMBER: 29-AS-20260512091539

FACILITY NAME:	CAMARILLO SENIOR LIVING		FACILITY NUMBER:	565850142
ADMINISTRATOR:	SCOTT KEAWEKANE		FACILITY TYPE:	741
ADDRESS:	6000 SANTA ROSA ROAD		TELEPHONE:	(805) 388-8086
CITY:	CAMARILLO	STATE: CA	ZIP CODE:	93012
CAPACITY:	140	CENSUS: 115	DATE:	09/24/2026
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Scott Keawekane		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not provide resident's responsible party with itemization of additional fees charged
Staff did not provide resident's responsible party with copy of reappraisal
Resident is being charged for services not provided

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA), Martha Arroyo conducted a subsequent complaint visit to the above facility. The purpose of the visit is to deliver findings for the above noted allegations. The initial complaint visit was conducted on 05/18/2026 by LPA M. Arroyo. On today's visit, LPA Arroyo met with Executive Director (ED), Scott Keawekane. Entrance interview.

During the initial visit on 05/18/2026, between 09:20 a.m. and 11:20 a.m., the LPA conducted interviews with three staff 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: 09/24/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2026

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 3

Control Number 29-AS-20260512091539

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: 09/24/2026

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

Report Continued from LIC 9099...

It was alleged that staff did not provide resident's responsible party with itemization of additional fees charged and resident is being charged for services not provided. It was reported that a rate sheet for add-on services that went above room and board were not provided and that the nebulizer treatments were a separate charge from the medication program. It was further reported that prior to Resident #1’s (R1’s) hospitalization, R1 was ambulatory, and had nebulizer treatments twice a week and upon R1’s return, R1 needed nebulizer treatments four times a day, which the facility notated to be a change in condition and started charging an additional fee of $1825 stating it was for the level of care change. However, the order was changed to “as needed” but the facility was still charging for the full amount monthly. Record review of the facility's Level of Care Fee Schedule revealed that the use of a nebulizer is assessed as a separate monthly charge from the medication program because it is considered a change in the resident's level of care. Per hospice care plan dated 02/17/2026, it indicated that R1 had physician's orders for Levalbuterol HCl Inhalation Nebulization Solution 1.25 mg, with one vial to be administered four times daily. On 04/20/2026, the physician's orders were revised to administer the medication every six hours as needed (PRN). Record review and interviews revealed that R1 returned from the hospital on 02/15/2026. A review of R1's monthly billing records showed that the facility began charging the $1,825 monthly nebulizer treatment fee effective 03/01/2026. Records further showed that the facility provided notice of this additional charge to R1's responsible party on 02/27/2026. Interviews with staff confirmed that nebulizer treatments were administered four times daily according to the physician's orders until the order was discontinued on 04/20/2026 and changed to PRN, every six hours. Interviews further revealed that R1 was charged for the nebulizer treatment from 03/01/2026 through 04/20/2026. The resident's responsible party was notified of the additional charge through telephone calls, emails, and in-person communication. Further review of billing records and staff interviews revealed that the facility prorated the nebulizer treatment charge for April 2026 and did not assess the monthly nebulizer fee for subsequent months after the routine nebulizer treatments were discontinued. Based on the information obtained and reviewed, the Department has insufficient evidence to support the allegations of “staff did not provide resident's responsible party with itemization of additional fees charged” and “resident is being charged for services not provided”. Therefore, these allegations are deemed Unsubstantiated at this time.

Report Continued on LIC 9099C...

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 29-AS-20260512091539

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: 09/24/2026

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

Report Continued from LIC 9099C...

It was also alleged that staff did not provide resident's responsible party with copy of reappraisal. It was reported that the facility claimed a level of care change due to the use of nebulizer treatments, however, a reappraisal was not provided to R1’s responsible party prior to the nebulizer charge. Record review of R1's Service Plan, dated 02/10/2026, indicated that the Medication Management section was updated to reflect new physician orders, including staff assistance with nebulizer treatments and inhaler administration, as prescribed. Additionally, the resident's responsible party received an updated Personal Care Assessment, effective 03/01/2026, documenting that R1 had begun receiving nebulizer treatments and that this additional service would result in an increased monthly charge of $1,825. Interviews conducted with staff revealed that an updated care plan was completed following R1's discharge from the hospital to reflect the resident's change in condition, including changes to R1’s medication management. Record review of facility documentation further indicated that R1's responsible party was informed of all changes. Staff stated that notification was provided through telephone calls, email correspondence, and in-person communication. Based on the information obtained and reviewed, the Department has insufficient evidence to support the allegation of “staff did not provide resident's responsible party with copy of reappraisal”. Therefore, this allegation is deemed Unsubstantiated at this time.

No citations issued 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: 09/24/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 3