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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 405850034
Report Date: 06/30/2022
Date Signed: 06/30/2022 10:53:22 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
03/26/2021 and conducted by Evaluator Darlene Chavez
COMPLAINT CONTROL NUMBER: 29-AS-20210326124605
FACILITY NAME:AVILA SENIOR LIVING AT DOWNTOWN SLOFACILITY NUMBER:
405850034
ADMINISTRATOR:MARSH, CHERYLFACILITY TYPE:
740
ADDRESS:475 MARSH STTELEPHONE:
(805) 706-0736
CITY:SAN LUIS OBISPOSTATE: CAZIP CODE:
93401
CAPACITY:100CENSUS: 57DATE:
06/30/2022
UNANNOUNCEDTIME BEGAN:
09:14 AM
MET WITH:Kari Bowron, Executive Director/AdministratorTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Staff not responding to resident's call button in a timely manner.
Facility is unsanitary.
INVESTIGATION FINDINGS:
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On 6/30/2022 at 9:14 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 allegations “Staff not responding to resident's call button in a timely manner,” and “Facility is unsanitary”, the complainant’s concern was that a resident called out for help and staff did not respond. Complainant went for help and after five minutes, requested help from staff again and waited a few minutes until staff arrived. Complainant also observed that the carpet in the resident’s room was heavily soiled. To investigate the allegation, LPA interviewed the administrator, residents, and staff and toured the facility.

Continued on 9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene ChavezTELEPHONE: (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)
Page: 1 of 3
Control Number 29-AS-20210326124605
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 4/02/21 at 11:39 am, LPA interviewed Mike Mayfield, Executive Director and Administrator. 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 explains that there is currently one housekeeper and that dining staff, concierge, and the maintenance director assist with cleaning when needed. He says that when a resident pushes their call pendant, staff are expected to respond “as quickly as possible” and that residents expect a “5-10 minute response.”

On 5/28/22 between 12:30 pm and 3:05 pm, LPA interviewed four residents. Resident #1 (R1) stated that when they call staff for assistance, they typically arrive within two to three minutes. R1 says staff used to pick up trash twice a day, but now they pick up trash once a day. R1 says there was a time when the plumbing in their bathroom had major back-up problems so R1 stayed with family, and R1 explained that the “Executive Director personally called me and said it was okay to go back to my room. I was very impressed that she gave me a call.” Resident #2 (R2) says that when they uses their call button, staff typically “arrive in a timely fashion, between two to three minutes.” R2 did say it would be nice if staff empty R2’s trash more than one day per week. Resident #3 (R3) remarked that they have not used their call pendant, however, R3 says “I hear the gentleman in the room above me who falls often and staff typically respond within two to three minutes.” R3 says that staff come in once a week to clean the room and daily to empty trash. R3 stated that they have contacted staff to clean or repair something and that it “takes about a half hour for them to get here.” Resident #4 (R4) says staff usually get to R4’s room within five minutes. R4 explains that staff pick up trash every day, and that one time, R4 accidentally spilled a drink on the carpet, and staff responded within two to three minutes.

On 6/09/22 at 4:34 pm, LPA interviewed Resident #5 (R5) who says they have not used their pendant to request staff assistance. R5 mentions that R5’s room is clean and that the housekeeper “takes care of it.”

On 6/10/22 at 2:44 pm, LPA interviewed Resident #6 (R6). R6 reports that they push their call pendant “several times a day” and that “staff respond in a reasonable amount of time, within 5-10 minutes.” R6 states they are very independent and when they spill “coffee” on the floor, they clean it themself. R6 mentioned a time when they had furniture break and they called staff with their pendant. R6 says “staff responded quickly.”

Continued on 9099-C.

SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene ChavezTELEPHONE: (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)
Page: 2 of 3
Control Number 29-AS-20210326124605
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 6/09/22 between 3:30 pm and 3:58 pm, LPA interviewed two staff. Staff #1 (S1) says there are two (2) caregivers and one (1) med-tech, and that the “caregivers are very busy in the morning, assisting residents with showers.” S1 explains that the med-tech helps residents who call for assistance when caregivers are busy helping other residents. Staff #2 (S2) reports that “about four times a month” they have had to leave a resident to care for another. S2 says that they have not seen any instances where residents were not helped.

On 6/09/22 at 3:30 pm, LPA toured the facility including two resident rooms. LPA did not observe any stains on the floors nor an unclean environment or furnishings.

Based on evidence obtained, the allegations “Staff not responding to resident's call button in a timely manner” and “Facility is unsanitary” are both deemed Unsubstantiated at this time. Resident interviews and LPA observations reveal that staff are responding in a reasonable amount of time and that the facility is generally clean.

Exit interview conducted and a copy of the report emailed to the Administrator.

SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene ChavezTELEPHONE: (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)
Page: 3 of 3