405850034-6-9-2022-29-AS-KBUY-CFDN66-20220614101036

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405850034
Report Date: 06/09/2022
Date Signed: 06/09/2022 03:11:47 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
03/18/2021 and conducted by Evaluator Darlene Chavez

COMPLAINT CONTROL NUMBER: 29-AS-20210318170032

FACILITY NAME:	AVILA SENIOR LIVING AT DOWNTOWN SLO		FACILITY NUMBER:	405850034
ADMINISTRATOR:	MARSH, CHERYL		FACILITY TYPE:	740
ADDRESS:	475 MARSH ST		TELEPHONE:	(805) 706-0736
CITY:	SAN LUIS OBISPO	STATE: CA	ZIP CODE:	93401
CAPACITY:	100	CENSUS: 57	DATE:	06/09/2022
		UNANNOUNCED	TIME BEGAN:	02:07 PM
MET WITH:	Kari Bowron, Executive Director		TIME COMPLETED:	03:25 PM

ALLEGATION(S):

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Insufficient staffing to meet residents' needs

INVESTIGATION FINDINGS:

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On 6/09/2022 at 2:07 pm, Licensing Program Analyst (LPA) Chavez conducted an unannounced complaint investigation follow-up visit. LPA met with Kari Bowron, Executive Director, and explained the reason for the visit.

On the allegation “Insufficient staffing to meet residents' needs,” the complainant’s concern was that residents were not receiving breakfast meals on-time and resident rooms were not being cleaned. Complainant reports that there is only one housekeeper on staff and when they are absent, residents do not get their rooms cleaned. To investigate the allegation, LPA interviewed administrator, residents, and staff.

On 3/25/21 at 3:56 pm, LPA Chavez interviewed Administrator Mike Mayfield. Administrator stated he did not agree with the allegation, however, he did say they have been “short staffed for awhile now.” He says they had to adjust the housekeeping schedule a bit. He explains that currently the facility has fewer residents than pre-COVID. He describes the residents as “demanding a lot” and have low activity. He says residents’ basic needs are prioritized and activities are growing.
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: 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.

LIC9099 (FAS) - (06/04)

Page: 1 of 4

Control Number 29-AS-20210318170032

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: 06/09/2022

NARRATIVE

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On 4/02/21 at 11:39 am, LPA interviewed the administrator again. Administrator states that housekeeping is done on a weekly basis and there is a schedule of which rooms are cleaned on Monday, Tuesday, etc. He says that apartments are not cleaned on Saturday and Sunday, and that on the weekends, common areas are cleaned. He explains that there is currently one housekeeper. He says it’s typical to have two housekeepers. He reports that dining staff, concierge, and maintenance director assist with cleaning when needed and says “There’s definitely a staffing shortage and we are challenged with getting staff.”

On 5/28/22 between 12:30 pm and 3:05 pm, LPA interviewed four residents. Three of the residents commented that “We need more people in the kitchen/dining room. They are slow to serve; They don’t have personnel to cover the Bistro, it used to be open daily, now it’s open one day a week; There are not enough staff in the early morning. I have to wait 20 minutes to get my medications.” One resident stated “There are enough staff to assist me in whatever is needed.” Another resident stated “The med-techs help serve food, and everybody has multiple jobs. Staff are very busy and it’s not fair that they have to help in other jobs.”

On 5/28/22 between 1:36 pm and 2:17 pm, LPA interviewed two dining services staff. One Staff #1 (S1) stated that “Staff help out wherever needed. Sometimes I can’t get to residents for one to five minutes.” S1 said that they work “12 hour shifts regularly during quarantine because it takes longer to deliver food to residents’ rooms than not to deliver.” S1 could not speak to the staffing levels in March 2021, however, S1 stated that “There have been only three servers since November 2021. One works breakfast and lunch, the other works lunch and dinner, and the other is a dining room service only.” Staff #2 (S2) are “short staffed” and that there is one server and one cook for 60-70 residents. “sometimes residents go home without a dessert.” S2 says that dining services staff call out for work “Five times per month. They don’t want to be here. They didn’t like the job or it was too overwhelming.” S2 explains that there is “often one caregiver on duty, over the radio and no one responds in a timely manner.” S2 further states that “other staff are helping in other departments who are not cross-trained.”

On 6/09/22 at 9:05 am, LPA reviewed the facility’s Personnel Report (LIC 500) dated 4/01/21 which indicates the facility had one housekeeper on staff. LPA reviewed the call button/pendant report for 3/01/21. The report does not show the time residents requested assistance nor the response time, however, there were 46 residents who used their pendants on 3/01/21.

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: 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

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 29-AS-20210318170032

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: 06/09/2022

NARRATIVE

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On 6/09/22 at 9:52 am, LPA reviewed staff schedule and residents’ medical assessments and care plans for March 2021. There were 22 out of 51 residents that were incontinent, 2 out of 51 residents on hospice, 15 out of 51 residents were non-ambulatory, 7 out of 51 needed assistance going to the restroom, and 8 out of 51 need transfer assist. Staff timesheets for 2/16/21 through 2/28/21 were reviewed and showed that there were 2 caregivers on the morning shift, 2 caregivers on the evening shift, and 2 caregivers on the NOC shift. Additionally, there was an average of 1-2 dining room servers per day during the period of 2/16/21 through 2/28/21.

Based on the evidence obtained, the allegation “Insufficient staffing to meet residents' needs,” is deemed Substantiated at this time. Records and interviews indicate that there was a low ratio of staff caring for residents’ needs. This causes an immediate health and safety risk to residents in care. Deficiency cited on 9099-D.

Exit interview conducted, a copy of the report, deficiency, and appeal rights emailed to the administrator and executive director.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene Chavez	TELEPHONE: (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

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 29-AS-20210318170032

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: 06/09/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 06/10/2022 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	87411(a) Personnel requirements – General. Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The Administrator agreed to submit an updated staffing schedule, submit a Statement of Understanding demonstrating how the facility will maintain adequate staffing to meet the needs of the residents. Submit updated staff schedule and Statement to CCL by 6/13/2022.
	8 9 10 11 12 13 14	Based on observation and record review, the licensee did not comply with the section cited above, as the facility experienced periods of insufficient staffing, which poses an immediate 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: 06/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022

LIC9099 (FAS) - (06/04)

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