405850034-9-8-2021-29-AS-DCHZ-C6P2JB-20210908172604

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 405850034
Report Date: 09/08/2021
Date Signed: 09/08/2021 05:26:57 PM

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 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: 50	DATE:	09/08/2021
TYPE OF VISIT:	POC	UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Cathyann Paape, Business Office Manager		TIME COMPLETED:	04:24 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	At 12:15 pm on 09/08/2021 Licensing Program Analyst (LPA) Chavez arrived at the facility to conduct a Plan of Correction (POC) visit. LPA met with Business Office Manager Cathyann Paape and requested documentation pertaining to the POC of the deficiency cited on 8/26/21. At 1:25 pm, LPA reviewed facility letters to residents dated 7/8/21 regarding credits for rent increases incurred 1/01/21 to 7/01/21. Of the forty-three letters needing to be signed showing residents acknowledge receipt of information, fifteen letters have been signed and twenty-eight letters remain un-signed. 12:50 pm, Ms. Paape informed LPA that Maria Quintera, Property Accountant, is working on the accounts needing adjustments for fifteen residents who moved out in 2021. Of these fifteen accounts, eight residents have not received refunds due. At 1:26 pm, LPA reviewed Resident #1 (R1)’s ledger for December 2020 through April 2021. Ledger reflects rent increases in January 2021 through April 2021 at which time R1 moved out. There are no adjustments made to reflect a credit for the rent increases. At 1:45 pm, LPA reviewed the ledger for Resident #2 (R2) for December 2020 through June 2021. Ledger reflects rent increase in January 2021 which was credited in February 2021. However, the ledger reflects that March – June 2021 have the rent increase and no credits were made by the time R2 left the facility. LPA reviewed fourteen additional ledgers, and eight still needed credits for 2021 rent increases. 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: 09/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 09/08/2021

NARRATIVE

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The following plans of correction are not met for case management visit 08-26-21:
1569.655(a) Health & Safety Code: If a licensee of a residential care facility for the elderly increases the rates of fees for residents or makes increases in any of its rate structures for services, the licensee shall provide no less than 60 days' prior written notice to the residents or the residents' representatives setting forth the amount of the increase, the reason for the increase, and a general description of the additional costs, except for an increase in the rate due to a change in the level of care of the resident. This subdivision shall not apply to optional services that are provided by individuals, professionals, or organizations under a separate fee-for-service arrangement with residents.

Exit interview conducted, civil penalty assessed, report and appeal rights emailed to Cathyann Paape.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene Chavez	TELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021

LIC809 (FAS) - (06/04)

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