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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405850034
Report Date: 11/10/2022
Date Signed: 11/10/2022 11:50:12 AM


Document Has Been Signed on 11/10/2022 11:50 AM - It Cannot Be Edited

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 SLOFACILITY NUMBER:
405850034
ADMINISTRATOR:KAREN ENCISOFACILITY TYPE:
740
ADDRESS:475 MARSH STTELEPHONE:
(805) 541-4222
CITY:SAN LUIS OBISPOSTATE: CAZIP CODE:
93401
CAPACITY:100CENSUS: 55DATE:
11/10/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:12 AM
MET WITH:Karen Enciso, Administrator, and Erika Hampe, Executive DirectorTIME COMPLETED:
12:10 PM
NARRATIVE
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On 11/10/22 at 11:12 am, Licensing Program Analyst (LPA) Chavez conducted a Case Management - Deficiencies visit to issue final findings and citations related to the Case Management visit conducted on 05/10/2022. LPA met with Karen Enciso, Administrator, and explained the reason for the visit.

On 05/10/2022, from 2:45pm to 4:00pm, Licensing Program Analyst (LPA) Darlene Chavez conducted an unannounced case management visit to the facility. LPA met with Karen Enciso, Administrator, and explained the reason for the visit. On 5/09/2022, the Administrator faxed an incident report (LIC 624) and a Report of Suspected Dependent Adult/Elder Abuse (SOC 341) to CCL stating that, on 5/07/2022, Resident #1 (R1) informed Staff #1 (S1) that R1 had been sexually abused by Staff #2 (S2) "approximately a week ago." During the visit, LPA interviewed the Administrator and S1, and obtained copies of pertinent documents. The LPA determined further investigation was needed. The case was referred to the CCL Investigations Branch (IB) and assigned to Investigator Ruben Munoz.

Investigator Munoz conducted interviews on 05/18/2022, at approximately 10:30am, with the Administrator; on 05/19/2022, from approximately 2:28pm to 3:00pm, with facility staff; on 05/26/2022, from approximately 8:49am to 9:33am, with facility staff; and on 05/27/2022, from approximately 9:30am to 11:26am, with R1, S2, and facility residents. In addition, Investigator Munoz reviewed facility file documents related to R1 and the San Luis Obispo State Parks Police Report.

On 11/26/2021, R1 was admitted to the facility. R1’s diagnoses include diabetes and Post Traumatic Stress Disorder (PTSD). R1 is independent and able to leave the facility unassisted.

Continued on 809-C.

SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene ChavezTELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:
DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/10/2022
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: 11/10/2022
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According to the Report of Suspected Dependent Adult/Elder abuse, on 05/07/2022, R1 reported to a facility staff that R1 had gone for a drive the previous week with S2 and S2 touched R1 inappropriately. S2 was placed on suspension pending further investigation. R1 was interviewed and stated that S2 offered R1 to take a ride with S2. On 04/27/2022, R1 had gone out for a ride with S2 earlier in the day and enjoyed S2’s company as they had similar likes in music. On the same day, after 7:00pm, R1 went down to the dining room to say goodnight to one of the servers and S2 followed R1 back to R1’s apartment and attempted to go into R1’s apartment. R1 told S2 they could not go into R1’s apartment. S2 asked if R1 wanted to go for a ride and R1 agreed. R1 fell asleep while S2 was driving and when R1 woke up, S2 had parked in a dark parking lot at Montana De Oro State Park Spooner’s Cove. S2 pulled R1 out of the car, leaned R1 against the car, attempted to kiss R1’s neck, touch R1’s buttock and breast. R1 pushed S2 away, hit S2 several times and told S2 they wanted to go home. S2 drove R1 back to the facility.

On 05/11/2022, at approximately 2:12pm, Officer Rushworth of the California State Parks Police obtained a statement from R1. The report documented the 04/27/2022 incident and no charges were filed as R1 declined to pursue sexual battery criminal charges against S2. The officer attempted to obtain a statement from S2, however, S2 was uncooperative, and the officer was unable to obtain a complete statement.

S2 admitted to Investigator Munoz and the Administrator to taking R1 out of the facility for a drive and they “kissed”. R1 stated S2 took R1 for a drive to the beach and S2 kissed R1. S2 also touched R1’s butt and tried to touch R1’s breast. According to the Administrator, it is against company’s policy for staff to take residents out of the facility without permission. S2’s last day worked at the facility was 05/06/2022 and employment terminated effective 05/13/2022.

Based on the information obtained throughout the course of the investigation, there is sufficient evidence to support the allegation of Sexual Abuse – Facility Staff sexually abused Resident, therefore the allegation is deemed Substantiated at this time.

Pursuant to Title 22, California Code of Regulations, the following deficiency is cited (refer to LIC 809-D).

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

SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene ChavezTELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 11/10/2022 11:50 AM - It Cannot Be Edited

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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/10/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/11/2022
Section Cited

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Additional Personal Rights of Residents in Privately Operated Facilities. Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be free from neglect...and verbal, mental, physical, or sexual abuse. This requirement is not met as evidenced by:
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Licensee terminated S2. Licensee will submit a plan to ensure all staff have ongoing training in personal rights of residents. Submit plan and proof of training to CCL by 11/11/22.
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Based on interviews and police record review, the licensee did not comply with the above section. S2 inappropriately touched R1, which posed an immediate health and safety risk to residents in care.
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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 BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene ChavezTELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:
DATE: 11/10/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/10/2022
LIC809 (FAS) - (06/04)
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