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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405850034
Report Date: 06/09/2022
Date Signed: 06/09/2022 03:15:14 PM


Document Has Been Signed on 06/09/2022 03:15 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: 57DATE:
06/09/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:07 PM
MET WITH:Kari Bowron, Executive DirectorTIME COMPLETED:
03:25 PM
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Licensing Program Analyst (LPA) Darlene Chavez arrived to this facility today for the purpose of conducting a Plan Of Correction (POC) visit to follow up on the Plan of Correction citation issued during the complaint investigation of 6/06/22 by LPA Chavez. At 2:07 pm, LPA met with Kari Bowron, Executive Director, and explained the reason for the visit.

On 6/07/22, the facility was cited for Regulation 87468.1 Personal Rights. Residents have the right to be accorded safe, healthful and comfortable accommodations, furnishings and equipment. The facility failed to ensure staff were wearing face coverings which poses an immediate health, safety and personal rights risk to residents in care. The Plan of Correction required the Executive Director (ED) to give S1 a final written warning, conduct infectious control training with staff emphasizing the reasons for proper use of PPE for residents and staff, and submit to CCLD by end of day 6/08/22 a staff sign-in sheet from the training with staff printed names, signatures, and date of training. Additionally, the ED is required to address the mask issue with the Dining Services Director, document the conversation, and send to LPA by 6/08/22.

The Proof of Correction was due on 6/08/22. As of end of day 6/08/22, the plan of correction is not met; civil penalty issued for failure to correct. A Civil Penalty will be issued for 6/09/22, one (1) day, at $100.00 per day.

Civil penalty issued in the amount of $100.00.

Exit interview conducted. A copy of the report, civil penalty, and appeal rights emailed to administrator and executive director.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene ChavezTELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:
DATE: 06/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/09/2022
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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