405850034-7-15-2022-29-AS-DCHZ-CGCVNJ-20220715163514

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 405850034
Report Date: 07/15/2022
Date Signed: 07/15/2022 04:36:34 PM

Document Has Been Signed on 07/15/2022 04:36 PM - 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 SLO		FACILITY NUMBER:	405850034
ADMINISTRATOR:	KARI BOWRON		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:	07/15/2022
TYPE OF VISIT:	Case Management - Deficiencies	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Emily Villegas, Activities Director		TIME COMPLETED:	05:00 PM

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On 7/15//2022 at 10:30 am, Licensing Program Analyst (LPA) Darlene Chavez conducted an unannounced complaint investigation visit. LPA met with Emily Villegas, Activities Director, and explained the reason for the visit.

During the investigation, LPA learned that the facility contacted Resident #2’s (R2) family requesting R2 to be evicted the same day as the notice.

On 6/17/22 at 4:40 pm, LPA spoke with Emily Villegas. LPA requested a copy of the re-appraisal, and this was not provided to LPA. Ms. Villegas states that she does not remember if R2 received a re-appraisal. Ms. Villegas says the family was called because R1 was not sleeping. Ms. Villegas believes the facility reached out to R2’s doctor, but she does not recall the outcome and could not provide documentation. She says that “the community was not a good fit for R2.”

On 6/17/21 at 10:11 am, LPA interviewed Witness #1 (W1). W1 explains that R2 was moved to another facility because someone at Avila Senior Living at Downtown SLO called W1 and demanded that W1 move R2 that same day. W1 says that while R2 was at the facility, “R2’s Dementia was beginning” and R2 was terrified that they couldn’t find their family. W1 says R2 didn’t know where their family was and that R2 made “several attempts” to leave the facility to look for them. W1 says “the facility made no attempts to get R2 help, they just moved R2 out.” W1 says W1 was able to find a new facility for R2 and moved R2 out within three days of the facility’s call. Records indicate that R2 moved out on 7/08/21.

On 7/12/22 at 1:42 pm, LPA reviewed the facility’s file for R2. There was an appraisal conducted on 6/22/21, three days prior to admission. There was no reappraisal in R2’s file and Administrator Kari Bowran states this is R2’s complete file.

Continued on 809-C.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene Chavez	TELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2022

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: 07/15/2022

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The facility identified that R2 was not a good fit for the facility, however, they did not conduct a reappraisal and contact R2’s physician to determine if the resident had a need not previously identified. A proper eviction procedure was not followed. The facility did not provide a 30-day written notice to R2 and their responsible party, did not conduct a reappraisal and update R2’s care plan indicating a change in condition, and did not consult with R2`s physician.

Pursuant to Title 22, California Code of Regulations, the deficiency will be cited on 809-D.

Exit interview conducted, deficiency cited, and a copy of this report and appeal rights emailed to the Administrator.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene Chavez	TELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 07/15/2022 04:36 PM - 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: 07/15/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/20/2022 Section Cited	1 2 3 4 5 6 7	87224(a)(4) Eviction Procedures (a) The licensee may evict a resident for one or more of the reasons listed in Section 87224...Thirty (30) days written notice to the resident is required except as otherwise specified...(4) If, after admission, it is determined that the resident... a reappraisal has been conducted... The facility did not meet the requirements as evidenced by:	1 2 3 4 5 6 7	Administrator has committed to thoroughly reviewing the Eviction Procedures (87224). Administrator will write a Statement of Understanding indicating a clear understanding and commitment to ensuring the Eviction Procedures are followed hereinafter. The Statement will be sent to CCL by 7/20/22.
	8 9 10 11 12 13 14	Based on staff and witness interviews and documentation, the licensee did not comply with the above regulation. The facility evicted the resident without 30 days’ written notice which poses a potential health and safety risk to resident in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: 07/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2022

LIC809 (FAS) - (06/04)

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