405850034-5-6-2022-29-AS-KBUY-CEDMHE-20220513093723

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405850034
Report Date: 05/06/2022
Date Signed: 05/06/2022 04:46:09 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
07/06/2021 and conducted by Evaluator Darlene Chavez

COMPLAINT CONTROL NUMBER: 29-AS-20210706104340

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:	05/06/2022
		UNANNOUNCED	TIME BEGAN:	04:25 PM
MET WITH:	Kaylene Duvall, Business Office Manager		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Facility does not have an administrator

INVESTIGATION FINDINGS:

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On 5/06/2022 at 4:25 pm, Licensing Program Analyst (LPA) Chavez initiated a complaint visit to discuss the final findings for the allegation listed above. LPA met with Kaylene Duvall, Former Business Office Manager, and informed of the reason for the visit.

On the allegation “Facility does not have an administrator”, the complainant’s concern was that “the facility has not had an administrator for several weeks” and that there are multiple problems happening at the facility due to the lack of an administrator. To investigate the allegation, LPA interviewed the Business Office Manager, the Regional Director of Operations, and residents, 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: 05/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20210706104340

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: 05/06/2022

NARRATIVE

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On 4/26/21 at 4:30 pm, LPA spoke with Cathyann Paape, former Business Office Manager, who stated that the former administrator was no longer with the facility effective 4/21/21. She informed LPA that Acting Administrator / Regional Director of Operations Cassondra Bradford is the temporary administrator. In an email on 4/30/21, temporary administrator Cassondra Bradford informed LPA that she would be at the facility one day a week until a replacement administrator was found. On 5/25/21, a memo was given to residents announcing Ms. Bradford as the Interim Executive Director.

On 5/05/22 at 4:30 pm, LPA reviewed emails from Cassondra Bradford. Ms. Bradford wrote that she was in the facility nine of the twelve weeks from 4/22/21 through 7/10/21, working 1-3 days per week. The remaining weeks, there were three Pacifica Senior Living staff who filled in. However, these staff did not meet qualifications to act in the administrator role.

On 6/04/21 between 10:03 am and 1:00 pm, LPA Chavez interviewed Resident #1 (R1), Resident #2 (R2), Resident #3 (R3), and Resident #4 (R4). R1 and R2 stated they thought “the salesperson was the administrator.” R3 said they “did not know who the administrator was” and commented that “there’s a lot of management turnover.” R4 explained that they were “aware that there was a new administrator and did not know the name.” R4 further commented that “I have never met her.” On 7/08/21 between 1:20 pm and 2:20 pm, LPA interviewed Resident #5 (R5) and Resident #6 (R6). R5 stated they did not know who the administrator was. LPA asked R6 and R7 if they knew whether the facility has an administrator, and R6 and R7 both replied “we don’t have one.”

On 7/08/21 at 11:51 am, LPA met with Cassondra Bradford, Interim Administrator. Ms. Bradford’s stated, “I am here at least two or three days a week.” LPA asked whether she has introduced herself to individual residents or in a meeting with residents, and she said she had met several residents by being in the community and talking with them, however, she could not provide resident names or dates.

On 5/05/22 at 5:30 pm, LPA reviewed facility records. There were 18 incident reports sent to CCL within this time period, three times the amount from the previous three months.

Based on interviews and record review, the allegation “Facility does not have an administrator” is deemed Substantiated at this time. Resident interviews indicate a lack of support from management, and records show an increase in resident incidents.

Exit interview conducted, deficiency cited, and a copy of the 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: 05/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2022

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20210706104340

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: 05/06/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/09/2022 Section Cited CCR 87405(a)	1 2 3 4 5 6 7	87405(a) Administrator - Qualifications and Duties. (a) All facilities shall have a qualified and currently certified administrator…The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility…	1 2 3 4 5 6 7	The licensee will ensure that the facility has one, qualified administrator a minimum 40 hours per week dedicated to the responsibilities of managing and administering of the facility. Licensee will email the name of the administrator, qualifications, and schedule to CCL by 5/9/2022.
	8 9 10 11 12 13 14	Based on staff and resident interviews and records review, the licensee did not comply with the regulation. The licensee did not provide an administrator on-site a sufficient number of hours to permit attention to the facility. This poses a potential health and safety risk to residents in care.	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: 05/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2022

LIC9099 (FAS) - (06/04)

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