Inspection
No deficiencies recorded in this report
MOM'S PLACE I
4 MANSFIELD LANE, Camarillo CA 93010
6 bedsLatest official report Apr 18, 2026Licensed
Additional info
- Telephone
- (818) 274-1809
- Licensee
- OMNICARE RESIDENTIAL LLC
- Administrator
- YUSUF, IBIRONKE
- Contact
- YUSUF, IBIRONKE
- License first date
- May 23, 2024
- License effective date
- May 23, 2024
- District office
- WOODLAND HILLS N.ASC · (818) 596-4334
- Regional office
- 29
- Clients served
- 935 - ELDERLY
Summary
The available records show 5 Type A and 3 Type B deficiencies for this facility.
- Most recent inspection
- Apr 18, 2026
- Most recent deficiency
- May 19, 2025
1 later report, on Apr 18, 2026, recorded no deficiencies, though the records do not say whether they were follow-ups.
What Type A and Type B mean
- Type A
- 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
- Violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care.
Both classifications are published by California CDSS and are shown as published. SeniorLivingFacts does not rename them or add a severity level of its own.
At a glance
Counts cover the five-year public record. Typical figures are the median for the 218 Ventura County facilities licensed for 6 or fewer beds.
In the available public five-year record, CCLD published 5 reports for this facility: 2 inspections, 0 complaint investigations, and 3 licensing or administrative records.
Those records contain 5 Type A and 3 Type B deficiencies.
0 deficiencies have explicit official correction or clearance evidence in the loaded records.
- Official inspections
- 2
- Recorded deficiencies
- 8
- Type A deficiencies
- 5
- Type B deficiencies
- 3
- Substantiated complaints
- 0
- Repeated topics
- 0
Fewer than the typical 4
1 in the last 12 months
Well above the typical 2
0 in the last 12 months
More than the typical 1
0 in the last 12 months
More than the typical 1
0 in the last 12 months
Most this size also have none
0 in the last 12 months
Last 36 months
Repeated topics
Topics cited in more than one report during the last 36 months. A repeat may show a pattern worth asking about. Each date opens its report below.
No topic repeats in the last 36 months
No deficiency topic appears in more than one report during that window. This does not establish that nothing repeated earlier in the five-year record, and it is not a statement about current conditions.
Official report history
All preserved reports from the most recent to the oldest, sortable by report type.
Inspection
Fire safety and emergency preparednessType A
- Official classification
- Type A
- Official code
- 87202(a)
- Regulation authority
- CCR
What the official deficiency says
(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in by having the fire door open and not hardwire to the smoke detectors which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 05/19/2025 Plan of Correction Facility representative immediately closed the door and stated that it will remained closed at all times.
Plan of correction recorded
Correction not verified in available records
Hazardous items and storageType A
- Official classification
- Type A
- Official code
- 87309(d)
- Regulation authority
- CCR
What the official deficiency says
(d) Residents may have access to items specified in subsection (c) for personal use unless there is documentation as specified in Section 87457, Pre-Admission Appraisal or Section 87463, Reappraisals, that indicates the resident's or other residents’ safety would be at risk if allowed access. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by having all chemicals in a closet to be secured with a deadbolt lock which does not requires a key to unlock which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 05/21/2025 Plan of Correction Handyman will come and change the deadbolt lock for a Keyed Entry deadbolt before POC due date.
Plan of correction recorded
Correction not verified in available records
Background checksType A
- Official classification
- Type A
- Official code
- 87355(e)(3)
- Regulation authority
- CCR
What the official deficiency says
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above by not having S1 associated to the faiclity which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 05/19/2025 Plan of Correction Licensee associated S1 during today's visit.
Plan of correction recorded
Correction not verified in available records
Medical and dental careType A
- Official classification
- Type A
- Official code
- 87465(d)
- Regulation authority
- CCR
What the official deficiency says
(d) If the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication, and is unable to communicate his/her symptoms clearly, facility staff designated by the licensee, shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by having discrepancies during today's medication audit which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 05/21/2025 Plan of Correction Facility respresentative will have training with staff regarding medication documentation and care staff notes. Training will be send to LPA before POC due date and a statement of understanding on regulation #87465(d) before POC due date
Plan of correction recorded
Correction not verified in available records
Facility condition and maintenanceType B
- Official classification
- Type B
- Official code
- 87303(a)
- Regulation authority
- CCR
What the official deficiency says
(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by having a broken toilet paper holder, broken electrical outlet and low water pressure from the faucet located in the bathroom of room #3 which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 07/03/2025 Plan of Correction Facility representative will have all these issues fixed and send proof to LPA before due date.
Plan of correction recorded
Correction not verified in available records
Resident rightsType B
- Official classification
- Type B
- Official code
- 87467(a)(3)
- Regulation authority
- CCR
What the official deficiency says
(a) Prior to, or within two weeks of the resident's admission, the licensee shall arrange a meeting with the resident, the resident's representative, if any, appropriate facility staff, and a representative of the resident's home health agency, if any, and any other appropriate parties, to prepare a written record of the care the resident will receive in the facility, and the resident's preferences regarding the services provided at the facility. (3) The licensee shall arrange a meeting with the resident and appropriate individuals identified in Section 87467(a)(1) to review and revise the written record as specified, when there is a significant change in the resident's condition, or once every 12 months, whichever occurs first. Significant changes shall include, but not be limited to occurrences specified in Section 87463, Reappraisals. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above bymissing signatures for resident's responsible party on all needs and service plans which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 07/03/2025 Plan of Correction Facility representative will contact every resident's responsible party to reviewed and sign all Needs and service plans.
Plan of correction recorded
Correction not verified in available records
Health conditions and treatmentsType B
- Official classification
- Type B
- Official code
- 87608(a)(5)(A)
- Regulation authority
- CCR
What the official deficiency says
(A) A bed rail that extends from the head half the length of the bed and used only for assistance with mobility shall be allowed. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above by not having a prescription or a note stating that full bed rails are required for R1 receiving hospice services which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 07/03/2025 Plan of Correction Facility representative will submit a copy of the prescription to LPA before POC due date.
Plan of correction recorded
Correction not verified in available records
Staffing, personnel, and trainingType A
- Official classification
- Type A
- Official code
- 87412(d)
- Regulation authority
- CCR
What the official deficiency says
The licensee shall maintain documentation that an administrator has met the certification requirements specified in Section 87406, Administrator Certification Requirements or the recertification requirements in Section 87407, Administrator Recertification Requirements. This requirement is not met as evidenced by: Deficient Practice Statement Based on interviews with staff, the licensee did not comply with the above cited section, as there is not a qualified administrator running the facility due to distance, which posed a potential health and safety risk to persons in care.
Official plan of correction
POC Due Date: 05/20/2025 Plan of Correction A statement of understanding shall be submitted to CCL before POC due date.
Plan of correction recorded
Correction not verified in available records
Licensing recordNot an inspection of the operating facility
No deficiencies recorded in this report
Licensing recordNot an inspection of the operating facility
No deficiencies recorded in this report
Licensing recordNot an inspection of the operating facility
No deficiencies recorded in this report
Source and limits
California Department of Social Services, Community Care Licensing Division. Public facility history is described by the source as a five-year window. Older records and previous-licensee history may require a regional-office request. Type 741 RCFE-CCRCs, nursing homes, and other care settings are excluded from this page.
Read the data methodology