405850034-6-30-2022-29-AS-KBUY-CFW2DG-20220630171819

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405850034
Report Date: 06/30/2022
Date Signed: 06/30/2022 10:57:30 AM

Unsubstantiated

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
03/21/2022 and conducted by Evaluator Darlene Chavez

COMPLAINT CONTROL NUMBER: 29-AS-20220321163140

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: 57	DATE:	06/30/2022
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Kari Bowron, Executive Director/Administrator		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff left rags with hazardous chemicals in the kitchen causing a chemical reaction

INVESTIGATION FINDINGS:

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On 6/30/2022 at 11:10 am, Licensing Program Analyst (LPA) Chavez conducted an unannounced complaint investigation follow-up visit. LPA met with Kari Bowron, Executive Director/Administrator, and explained the reason for the visit.

On the allegation “Staff left rags with hazardous chemicals in the kitchen causing a chemical reaction,” the complainant’s concern was that a pile of rags that had been used to clean the dining room tables was left on a mat in the kitchen and began to smoke, possibly because of a chemical reaction between the products used to clean the mat and what was on the rags. To investigate the allegation, LPA interviewed staff and vendor.

Continued on 9099-C.

Unsubstantiated

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: 06/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2022

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-20220321163140

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: 06/30/2022

NARRATIVE

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On 3/23/22 at 11:30 am, LPA interviewed Residential Services Director Alex Arellano. Mr. Arellano stated that Staff #1 (S1) was on shift the evening when the fire alarm sounded. He says it happened around 12:30 – 1:00 am on 3/15/22. Mr. Arellano says that the fire alarm in the kitchen went off due to steam coming from a bag of rags that had just been laundered. He explains that the “trash bag” had rags that are used for the kitchen and that they had just come from the dryer. He says the bag was not completely closed when placed on the floor in the kitchen, and the tie must have come undone. He says the steam from the bag made the alarm sound. He says the alarm company would be the one to contact the fire department, if needed, but that the fire department did not show-up when the alarm sounded. Mr. Arellano states that the rags “possibly were not fully cleaned and may have had grease on them with the hotness from the dryer” and that may have caused the steam or smoke.

On 6/01/22 at 3:23 pm, LPA interviewed Witness #1 (W1) from Alpha Fire Unlimited which is the alarm company used at the facility. W1 stated that the alarm located in the facility’s kitchen can detect smoke and that “steam can mimic smoke.” W1 explained that “particles in steam can set off an alarm.” W1 said that on a cold day, if the room is cold, and steam enters it, the alarm can be sensitive and detect steam. LPA explained the situation that occurred in the facility’s kitchen with the bag of rags that had recently been taken out of the dryer, sitting approximately 10-12 feet from the detector. W1 stated that “It sounds like a false alarm is what happened.”

On 6/27/22 at 10:13 am, LPA spoke with S1. S1 stated that on 3/15/22 at approximately 12:00 am, S1 placed a trash bag with approximately 20 rags on a folding serving tray in the kitchen under the smoke detector. S1 says the bag was about 8 feet below the detector and that the rags were “steaming hot” as they were just taken from the dryer. S1 described the bag as being open when placed on the tray and that there was “a lot of steam.” S1 explains that the rags are used to clean the oven, however, S1 states that they did not see any grease on the rags. S1 says that the smoke alarm activated 30 minutes after S1 set the bag down in the kitchen. S1 called 9-1-1 and told them it was a false alarm and that there was no fire. The alarm company called the facility, and S1 says S1 told them it was a false alarm.

Based on evidence obtained, the allegation “Staff left rags with hazardous chemicals in the kitchen causing a chemical reaction,” is deemed Unsubstantiated at this time. Interviews indicate that there was not a hazardous situation that occurred in the kitchen causing the alarm and that no residents were in danger.

Exit interview conducted and a copy of the report 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: 06/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2022

LIC9099 (FAS) - (06/04)

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