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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405850034
Report Date: 05/10/2022
Date Signed: 05/10/2022 04:28:39 PM


Document Has Been Signed on 05/10/2022 04:28 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:KAREN L ENCISOFACILITY TYPE:
740
ADDRESS:475 MARSH STTELEPHONE:
(805) 541-4222
CITY:SAN LUIS OBISPOSTATE: CAZIP CODE:
93401
CAPACITY:100CENSUS: 60DATE:
05/10/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Karen Enciso, AdministratorTIME COMPLETED:
04:00 PM
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On 5/10/22 at 2:45 pm, Licensing Program Analyst (LPA) Darlene Chavez conducted an unannounced case management visit to the facility above. LPA met with Karen Enciso, Administrator, and explained the reason for the visit.

On 5/09/22, Administrator faxed an incident report (LIC 624) and Report of Suspected Dependent Adult/Elder Abuse (SOC 341) to CCL stating that, on 5/07/22, Resident #1 (R1) informed Staff #1 (S1) that R1 had been sexually abused by Staff #2 (S2) "approximately a week ago." Today, LPA interviewed the administrator and S1, and obtained documentation. Further investigation is needed.

Exit interview conducted and a copy of the report emailed to the administrator.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene ChavezTELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:
DATE: 05/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/10/2022
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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