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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405850034
Report Date: 04/30/2021
Date Signed: 04/30/2021 04:23:07 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:AVILA SENIOR LIVING AT DOWNTOWN SLOFACILITY NUMBER:
405850034
ADMINISTRATOR:MICHAEL MAYFIELDFACILITY TYPE:
740
ADDRESS:475 MARSH STTELEPHONE:
(805) 706-0736
CITY:SAN LUIS OBISPOSTATE: CAZIP CODE:
93401
CAPACITY:100CENSUS: 47DATE:
04/30/2021
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
03:13 PM
MET WITH:Cathyann Paape, Business Office ManagerTIME COMPLETED:
03:37 PM
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Licensing Program Analyst (LPA) Chavez conducted a Case Management visit to the facility due to a COVID-19 concern that was brought to CCLD’s attention regarding facility staff was not wearing a face mask in facility. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s visit was conducted by video chat with Business Office Manager Cathyann Paape.

A credible witness (W1) visited the facility and observed an employee in the facility not wearing a mask. On 4/30/2021 at 3:13 pm, LPA conducted an unannounced televisit with the Business Office Manager. LPA conducted a facility tour and observed ten (10) staff in the receptionist area, dining room, kitchen, outside patio, wellness center, and hallway. All staff were wearing face coverings. Ms. Paape stated that the only time staff pull down their mask is to speak with another employee who is hard of hearing. LPA recommended staff who engage with said employee should wear a clear mask so said employee can read lips. LPA reminded that all staff are required to wear a face covering while in the facility.

LPA phoned interim Administrator Cassondra Bradford to inform of the concern and encourage further communication and training with staff to ensure staff are wearing face coverings at all times in the facility. Ms. Bradford stated she would be sure to train staff on Monday, 5/03/2021, the next time she’s in the facility.

No violations were noted at this time. An exit interview was conducted, and a copy of this report was emailed to Business Office Manager for signature and return. A copy of the report was sent to Interim Administrator.

SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene ChavezTELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:

DATE: 04/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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