405850034-5-4-2022-29-AS-KBUY-CE6UJP-20220506153751

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405850034
Report Date: 05/04/2022
Date Signed: 05/04/2022 05:33:24 PM

Substantiated

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
12/17/2021 and conducted by Evaluator Darlene Chavez

COMPLAINT CONTROL NUMBER: 29-AS-20211217151850

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: 58	DATE:	05/04/2022
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Karen Enciso, Back-up Administrator, Operations Specialist		TIME COMPLETED:	05:40 PM

ALLEGATION(S):

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Facility does not provide a safe environment for residents in care.

INVESTIGATION FINDINGS:

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On 5/04/2022 at 10:45 am Licensing Program Analyst (LPA) Chavez conducted an unannounced complaint visit with final findings to the facility listed above. LPA met with Karen Enciso, Back-up Administrator and Operations Specialist, and explained the purpose of the visit.

Regarding the allegation “Facility does not provide a safe environment for residents in care,” the complainant’s concern was that the electrical power in Resident #1’s (R1) room “has gone out several times recently and not restored for several hours.” Complainant explains that this causes a safety problem due to R1 not having sufficient lighting and being a fall risk. To investigate the allegation, LPA interviewed Executive Director Emily Villegas, staff, and resident, and reviewed records.

Continued on 9099-C.

Substantiated

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: 05/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022

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 4

Control Number 29-AS-20211217151850

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: 05/04/2022

NARRATIVE

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On 12/16/21 at 4:35 pm, LPA interviewed a credible witness #1 (W1) who stated that Resident #1 (R1) had “intermittent power and this is the second time” due to construction taking place below R1’s apartment. W1 states that R1 was without power “midday 12/15/21 and still not on 12/16/21 at 4:00 pm.” W1 explains that R1 spoke to the Maintenance Director on 12/16/21, and that the Director “did not know anything about it but will get on it.” W1 describes R1 as being in a manual wheelchair and is a fall risk. W1 clarifies that R1’s room has some electricity working, specifically “one lamp plugged into the wall, heat lamps in the bathroom, heater, microwave, refrigerator, and some of the sockets.”

On 12/16/21 at 4:45 pm, LPA interviewed Executive Director Emily Villegas. Ms. Villegas said she was aware of the situation in R1’s room and that “there is an electrician coming to the facility tonight between 7:00 pm and 8:00 pm to fix the electrical problem in R1’s room.” She explained that “this afternoon” she learned of the problem and was also aware of a situation that happened “two weeks ago when the power went out and a breaker was fixed.” She continues that “Today, there is no power in R1’s room and that the Maintenance Director checked the breakers, and it’s not a breaker problem.”

On 12/16/21 at 4:57 pm, LPA spoke with R1. R1 says R1 informed “the maintenance guy today that they had no electricity, and that the maintenance guy brought R1 an extension cord.” R1 stated that they believes the electrical problem is due to the construction that is happening directly below R1’s room. R1 notified LPA that there was a housekeeper in their room cleaning broken glass in the bathroom. R1 explains that maintenance brought a lamp for the bathroom, and R1 clipped the cord with their wheelchair, and the lamp fell on the floor. R1 reports no injury.

On 12/22/21 at 11:45 am, LPA toured R1’s room and the rooms on the first floor below R1’s room. LPA observed that rooms on the first floor below R1’s room were being remodeled. LPA went into R1’s room and tested the electricity. Lights in the living room, bathroom, and bedroom, including lamps, were working.

On 5/4/22 at 11:15 am, LPA reviewed the facility’s maintenance requests. Records show that a request was placed on 11/28/21 stating “electric out on a couple of circuits.” There were no maintenance requests for R1’s room between 12/15/21 and 12/18/21.

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: 05/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20211217151850

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: 05/04/2022

NARRATIVE

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On 5/4/22 at 11:21 am, LPA interviewed Staff #1 (S1). S1 stated that on 11/28/21 R1 requested “an extra lamp” which S1 provided. LPA asked S1 about the maintenance request dated 11/28/21 which states “electric out on a couple of circuits” for R1’s room. S1 said that the construction guys working on the memory care units below R1’s room tripped the breakers. S1 explains this happened a couple of times from 11/28/21 through 11/30/21 and that electricity in R1’s room was out approximately 5-10 minutes each time.

S1 also described the situation when R1 had partial electricity in their room on 12/17/21. S1 says that construction crews working on the units below R1’s room “cut a wire that took out some of the power in R1’s room.” S1 describes R1’s power as being “out for a whole day.” S1 says the “wire was cut on Friday, 12/17/21 sometime before 5:00 to 6:00 pm when S1 was notified.” S1 says they checked on R1 around 6:00 pm to see if R1 “saw or felt anything,” then went to assess the electrical situation. S1 says they returned to R1’s room about 15 to 20 minutes later and ask if R1 needed anything to which R1 replied they needed lighting. S1 returned with an extension cord, plugged it into an outlet in R1’s room that worked, and connected the two lamps currently in R1’s room. S1 says they called the construction company to come back and fix the electrical problem, and the construction person arrived on 12/18/21 between 7:15 am and 8:15 am and fixed the outage.

Based on evidence obtained, the allegation “Facility does not provide a safe environment for residents in care,” is deemed Substantiated at this time. Interviews reveal that R1 was without power on more than two occasions and between 12/15/21 and 12/18/21, R1 had only partial electricity and insufficient lighting for a period of more than 24 hours which caused a safety concern.

Exit interview conducted, deficiency cited, and report and appeal rights emailed to administrator.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene Chavez	TELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 29-AS-20211217151850

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/04/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/11/2022 Section Cited CCR 87303(d)	1 2 3 4 5 6 7	87303 Maintenance and Operation. (d) There shall be lamps or light appropriate for the use of each room and sufficient to ensure the comfort and safety of all persons in the facility. The facility did not meet the requirements as evidenced by:	1 2 3 4 5 6 7	Administrator has fixed the immediate safety concern. Administrator has committed to offering R1 a temporary relocation while construction is being done to the units below. Administrator will provide CCLD with a status by 5/09/22.
	8 9 10 11 12 13 14	Based on staff, resident, and witness interviews and record review, the licensee did not comply with the regulation. The facility did not provide sufficient lighting for R1 in a timely manner.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene Chavez	TELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022

LIC9099 (FAS) - (06/04)

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