405850034-7-12-2022-29-AS-KBUY-CGCQUA-20220715122824

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405850034
Report Date: 07/12/2022
Date Signed: 07/12/2022 03:58:38 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
05/04/2022 and conducted by Evaluator Darlene Chavez

COMPLAINT CONTROL NUMBER: 29-AS-20220504112657

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:	07/12/2022
		UNANNOUNCED	TIME BEGAN:	12:49 PM
MET WITH:	Kari Bowron, Executive Director/Administrator		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Facility is not providing residents transportation to medical appointments.

INVESTIGATION FINDINGS:

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On 7/12/2022 at 12:49 pm, Licensing Program Analyst (LPA) Chavez initiated an unannounced complaint visit to discuss the final findings for the allegation listed above. LPA met with Kari Bowron, Executive Director/Administrator, and explained the reason for the visit.

On the allegation “Facility is not providing residents transportation to medical appointments,” the complainant’s concern was that the facility did not provide transportation or make arrangements for transportation for residents’ medical appointments. Complainant reported that the facility told residents they could not pick them up from medical appointments that the facility had transported them to. To investigate the allegation, LPA interviewed the complainant, Witness #1 (W1), and resident, and reviewed facility 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: 07/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2022

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-20220504112657

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: 07/12/2022

NARRATIVE

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On 4/26/22 at 1:03 pm and on 4/27/22 at 3:10 pm, LPA spoke with Witness #1 (W1). W1 explains a situation where the facility did not provide transportation for Residents #1 and #2 (R1 and R2). W1 says that R1 and R2 had two medical appointments in the same day, and the facility told them they could only take R1 and R2 to one of their appointments and that they had to make alternate arrangements for transportation to their second appointments. Additionally, R1 confirmed with the facility prior to going to R1’s appointment that the facility would pick up R1 at their medical appointment. When R1 called the facility for a return ride, R1 that the facility would be unable to provide this transportation. Staff #1 (S1) called R1’s responsible party to request they transport R1.

On 7/07/22 at 4:10 pm, LPA interviewed Resident #3 (R3). R3 described incidents that occurred in early July 2022 where R3 requested transportation to two doctor appointments, and S1 told R3 that “no one is available to transport you.” Further, S1 told R3 that they would have to arrange the transportation themselves. R3 says R3 provided the transportation form to S1 “at least 48 hours in advance.”

On 7/11/22 at 2:30 pm, LPA reviewed the facility’s Plan of Operation for transportation to medical appointments which states: “Should the resident not have transportation, the community arranges for necessary transportation.” In the section Basic Services under Transportation, “The community will arrange and/or provide transportation to scheduled medical and dental appointments, shopping, dining and specified community events in a 25-mile radius. Transportation is available from 8 a.m. to 5 p.m. on designated days.”

In the facility’s admission agreement, it states “We will make available to residents, or otherwise assure the provision of, scheduled transportation to the nearest appropriate health facilities for medical and dental appointments, social services agencies, shopping and recreational facilities within a 12-mile radius. Transportation is available from 8:30 a.m. to 3:30 p.m., on designated days. Other transportation outside normal business hours may be arranged by the Resident with the Community’s Activities Director for an additional charge, or with an outside agency.”

Based on the evidence obtained, the allegation “Facility is not providing residents transportation to medical appointments,” is deemed Substantiated. The facility is not providing basic transportation services to residents in care.

Exit interview conducted, deficiency cited, civil penalty issued, and a copy of 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: 07/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2022

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20220504112657

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: 07/12/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/19/2022 Section Cited CCR 87465(a)(2)	1 2 3 4 5 6 7	87465(a)(2) - Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility… (2) The licensee shall provide assistance in meeting necessary medical and dental needs. This includes transportation... The facility did not meet the requirements as evidenced by:	1 2 3 4 5 6 7	Administrator has committed to training staff on transportation requirements and send a training sign-in sheet with staff signatures to LPA by 7/19/22.
	8 9 10 11 12 13 14	Based on staff, resident and witness interviews and documentation, the licensee did not comply with the above regulation, the facility did not aid with meeting residents’ medical needs and transportation which poses a potential health and safety risk to residents in care.	8 9 10 11 12 13 14
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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: 07/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2022

LIC9099 (FAS) - (06/04)

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