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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405850034
Report Date: 03/23/2022
Date Signed: 03/23/2022 04:38:52 PM


Document Has Been Signed on 03/23/2022 04:38 PM - It Cannot Be Edited

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:CASSONDRA BRADFORDFACILITY TYPE:
740
ADDRESS:475 MARSH STTELEPHONE:
(805) 541-4222
CITY:SAN LUIS OBISPOSTATE: CAZIP CODE:
93401
CAPACITY:100CENSUS: 59DATE:
03/23/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Emily Villegas, Executive DirectorTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Chavez conducted an unannounced Plan of Correction (POC) visit to follow up on the Plan of Correction citation issued during a complaint visit conducted on 03/08/2022. LPA met with Emily Villegas, Executive Director, and explained the purpose of the visit.

On 03/08/2022, the facility was cited for invalid rate increases for the monthly care fees. The Proof of Correction was due on 03/09/2022. The Plan of Correction consisted of notifying all residents and residents’ representatives in writing that the rate increase is rescinded and provide CCL with a copy of each written notice. On 03/10/2022, CCL received a letter from the administrator stating the facility would notify residents by 03/15/2022. As of today, the Plan of Correction is not met and a civil penalty issued for failure to correct. Civil Penalties will be issued for period 03/09/22 – 03/23/22, which is a total of fifteen (15) days, at $100.00 per day. Civil Penalties will accrue until the Plan of Correction is met.

Exit interview conducted. A copy of the report was issued. Civil penalties and related appeal rights issued.

SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene ChavezTELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:
DATE: 03/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/23/2022
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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