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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405850034
Report Date: 08/26/2021
Date Signed: 08/26/2021 04:59:49 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:CASSONDRA BRADFORDFACILITY TYPE:
740
ADDRESS:475 MARSH STTELEPHONE:
(805) 541-4222
CITY:SAN LUIS OBISPOSTATE: CAZIP CODE:
93401
CAPACITY:100CENSUS: 53DATE:
08/26/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:56 AM
MET WITH:Cathyann Paape, Business Office ManagerTIME COMPLETED:
03:12 PM
NARRATIVE
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On 8/26/21 at 11:56 am, Licensing Program Analyst (LPA) Chavez visited the facility to follow-up on a Plan of Correction issued on 7/01/21. LPA met with Cathyann Paape, Business Office Manager, and explained the reason for the visit. Ms. Paape provided statements and ledgers for four (4) residents for the time period of 1/01/21 through 8/01/21. LPA reviewed a sample size of four (4) resident statements and ledgers. One (1) resident received proper rental increase credits. Two (2) residents did not receive rental increase credits as of today. At 1:05 pm, Ms. Paape stated that these residents are former residents and all former residents have not had adjustments or credits made to their accounts yet. The fourth (4th) resident's ledger contained errors. There were eight (8) charges of $550 each for a total of $4,400 needing to be credited to the resident. Ms. Paape states that this resident had a rent freeze. The ledger shows credits for the rental increase, however, LPA questioned why the resident would incur a rent increase if the resident has a rent freeze. Ms. Paape stated that the freeze was not noted in the facility's ledger system. Ms. Paape further mentioned that the resident brought it to her attention to have it corrected.


As part of the Plan of Correction, the facility was to confirm that all current and former residents received a letter from facility by 7/07/21 stating that the rental increase will be removed or credited from their accounts for January 2021 to June 2021. Ms. Paape provided a copy of the 7/08/21 letter and five (5) signed letters from residents or their persons of responsibility. Ms. Paape states there were thirty-two (32) letters sent out, therefore, twenty-seven (27) letters remain unsigned.

The facility is not incompliance with the providing a 60-day written notice to residents of the rent increase and crediting current and former residents for the rental increases incurred in 2021. Deficiency cited.

Exit interview conducted, and report, deficiency, and appeal rights emailed to Ms. Paape.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene ChavezTELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 08/26/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/01/2021
Section Cited

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1569.655(a) Health & Safety Code
If a licensee of a residential care facility for the elderly increases the rates of fees for residents...licensee shall provide no less than 60 days' prior written notice to the residents or the residents' representatives...
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Based on record review, facility communication, and resident documents, the licensee failed to ensure a safe environment by having residents incur additional costs without proper notice which poses a potential safety risk to residents in care.
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The facility's rental increase adjustment letter dated 7/8/21 will be signed by all residents or their person of responsibility by the due date of 9/01/21.

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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 BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene ChavezTELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:
DATE: 08/26/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/26/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2