405850034-4-20-2022-29-AS-KBUY-CDR2XA-20220422174648

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405850034
Report Date: 04/20/2022
Date Signed: 04/20/2022 04:47:07 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
04/14/2022 and conducted by Evaluator Darlene Chavez

COMPLAINT CONTROL NUMBER: 29-AS-20220414141626

FACILITY NAME:	AVILA SENIOR LIVING AT DOWNTOWN SLO		FACILITY NUMBER:	405850034
ADMINISTRATOR:	CASSONDRA BRADFORD		FACILITY TYPE:	740
ADDRESS:	475 MARSH ST		TELEPHONE:	(805) 541-4222
CITY:	SAN LUIS OBISPO	STATE: CA	ZIP CODE:	93401
CAPACITY:	100	CENSUS: 60	DATE:	04/20/2022
		UNANNOUNCED	TIME BEGAN:	12:10 PM
MET WITH:	Karen Enciso, Operations Specialist, Cassondra Bradford, Regional Director, Emily Villegas, Exec. Dir.		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff mismanaging resident's medications.
Residents are not provided activities.
Facility is not properly storing food items.

INVESTIGATION FINDINGS:

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On 4/20/2022 at 12:10 pm, Licensing Program Analyst (LPA) Darlene Chavez initiated an unannounced 10-day complaint visit. LPA met with Karen Enciso, Operations Specialist, Cassondra Bradford, Regional Director, and Emily Villegas, Executive Director.

On the allegation “Staff mismanaging resident's medications,” the complainant’s concern was that staff were not delivering all medications and delivering medications before or after designated distribution times. To investigate the allegation, LPA conducted staff and resident interviews.

Continued on 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene Chavez	TELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2022

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-20220414141626

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: AVILA SENIOR LIVING AT DOWNTOWN SLO	FACILITY NUMBER: 405850034
	VISIT DATE: 04/20/2022

NARRATIVE

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At 12:15 pm, LPA interviewed Executive Director (ED) who stated that there is one Resident #1 (R1) who refuses medications at the time staff deliver and requests medications to be delivered “in an hour.” ED states that when staff return, R1 asks for a deferral again. At 1:05 pm, LPA interviewed Staff #2 (S2) who stated that when S1 tries to deliver medications to R1, R1 asks to “push back the time on medications.” S2 states that R1 has medications that are needed at a particular time and that R1 requests a later time. At 1:20 pm, LPA interviewed Staff #3 (S3) who stated that S3 delivers medications to R1, and R1 asks to come back later. S3 states when S3 runs late in delivering medications, R1 gets upset and wants the medications on-time.

Between 1:30 pm and 3:02 pm, LPA interviewed six residents who stated they receive all of their medications and on-time. Two residents interviewed stated there have been one or two occasions where they were asleep when the med-tech arrived to deliver medications, and the med-tech came into their room to check on them because residents did not answer their doors. One resident stated that when they leave the facility for more than a day, staff provide medications in an envelope and it is marked with day and time to take medications.

Based on the evidence obtained, the allegation “Staff mismanaging resident's medications,” is deemed Unsubstantiated. Resident interviews reveal that staff are providing all medications prescribed to residents and delivering medications on-time.

On the allegation “Residents are not provided activities,” the complainant was concerned that there was a lack of activities available to residents and that the facility does not have a full-time, designated activities lead. To investigate the allegation, LPA interviewed Executive Director and residents and reviewed documentation.

Between 1:30 pm and 3:02 pm, LPA interviewed six residents. One resident stated that they do not participate in the activities. The other five residents stated that they feel the facility offers “plenty” of activities. They clarify that activities are offered at least three to four times per week and include Bingo, games, puzzles, live music, shopping, gardening, church service, movies, happy hour, and book club. They said the facility has a designated activities person, Staff #4 (S4), who conducts the activities along with the ED. One resident stated that the facility is “getting more activities all the time.”

Continued on 9099-C.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene Chavez	TELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 29-AS-20220414141626

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: AVILA SENIOR LIVING AT DOWNTOWN SLO	FACILITY NUMBER: 405850034
	VISIT DATE: 04/20/2022

NARRATIVE

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At 1:20 pm, LPA reviewed and discussed the activities calendar with the ED. There are at minimum four activities per day, seven days a week.

Based on interviews and records review, the allegation “Residents are not provided activities,” is deemed Unsubstantiated at this time. Resident interviews reflect that residents are fulfilled with activities offered by the facility and records reviewed list a healthy quantity and variety of daily activities.

On the allegation, “Facility is not properly storing food items,” the complainant was concerned that they observed uncovered food on the kitchen counter. To investigate the allegation, LPA interviewed kitchen staff and toured the kitchen.

On 4/20/2022 at 2:15 pm, LPA toured the kitchen. LPA observed a kitchen with clean counters and equipment, no food on the counters, and food properly stored in refrigerators and pantry. At 2:28 pm, LPA interviewed the Dining Services Director, Staff #5 (S5). S5 explained that there was a “roasting pan of pork tenderloin sitting on the counter for approximately ten minutes” on 4/12/2022. At 2:26 pm, LPA interviewed Staff #6 (S6) who stated that they had the pan of pork tenderloin on the counter for approximately ten minutes while prepping it with spices before placing it in the oven. S6 says the tenderloin “takes a lot of spices.”

Based on evidence obtained, the allegation “Facility is not properly storing food items,” is deemed Unsubstantiated at this time. Food observed on kitchen counter was not being stored but rather prepped for cooking.

Exit interview conducted and a copy of report emailed to administrators and executive director.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene Chavez	TELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2022

LIC9099 (FAS) - (06/04)

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