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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 405850034
Report Date: 09/08/2021
Date Signed: 09/08/2021 05:31:18 PM



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
06/15/2020 and conducted by Evaluator Darlene Chavez
COMPLAINT CONTROL NUMBER: 29-AS-20200615164301
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: 50DATE:
09/08/2021
UNANNOUNCEDTIME BEGAN:
03:29 PM
MET WITH:Cathyann Paape, Business Office ManagerTIME COMPLETED:
04:24 PM
ALLEGATION(S):
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Staff did not provide resident with clean linens
Resident’s room is unsanitary
INVESTIGATION FINDINGS:
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On 9/08/21 at 3:30 pm, Licensing Program Analyst (LPA) Darlene Chavez initiated a complaint visit to discuss the final findings for the allegations listed above. LPA met with Cathyann Paape, Business Office Manager, and informed her of the reason for the visit.

On the allegation “Staff did not provide resident with clean linens”, the complainant’s concern was that Resident #1 (R1) had dirty bed sheets and no towels in R1’s room. To investigate the allegation, LPA interviewed the former administrator, Cheryl Marsh, on 6/24/20 at 11:12 am, two witnesses (W1 & W2) on 8/30/21 at 10:17 am and 1:38 pm respectively and attempted to interview the complainant on 6/24/20 at 10:33 am and 8/30/21 at 1:31 pm. LPA also toured the facility, obtained laundry records, and reviewed a letter submitted by W1 dated 6/14/20.

Continued on 9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene ChavezTELEPHONE: (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.
LIC9099 (FAS) - (06/04)
Page: 1 of 6
Control Number 29-AS-20200615164301
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: 09/08/2021
NARRATIVE
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On 6/24/20 at 11:35 am, LPA toured R1’s room via televisit with Administrator Marsh and S2. LPA Chavez observed one linen on the bed, two hand towels in the bathroom, one hand towel on the hall counter top, and one sheet on the bed.

On 7/21/21, LPA reviewed the R1’s Admission Agreement and Laundry records. R1’s admission agreement states on page 2, Section 1, B, 5 that the facility “will provide bed and bath linen services in your Residence weekly.” The laundry schedule shows that laundry service was to be performed weekly, every Thursday for R1. For the time period of 4/21/20 through 6/26/20, R1 should have received nine weeks of service. However, laundry records indicate R1 received laundry service only on two (2) weeks, 4/30/20 and 5/07/20.

On 8/30/21 at 10:17 am, LPA spoke with W1 who visited R1 at least weekly. W1 stated in a letter and further corroborated in the interview with LPA that in a visit on 6/13/20, R1’s “bed was un-made and the linens were filthy.” W1 states that with the previous owners “It was a fine place,” “however, since the new owners/corporate took over, the care, food, and maintenance went down.” In a letter W1 wrote on 6/14/20, W1 states “The bathroom was dirty and there wasn’t even a towel available to wipe R1’s hands on.”

On 8/30/21 at 1:38 pm, LPA spoke with W2 who visited R1 one to two times per week and recalled a visit on 6/13/20 from 1:00 pm to 3:00 pm. W1 stated that R1’s room was “a mess and linens appeared to not have been changed in a while.”

Based on the information obtained, the allegation that, “Staff did not provide resident with clean linens”, is Substantiated. The facility did not provide R1 with clean linen, including blankets, bedspreads, top bed sheets, bottom bed sheets, pillow cases, mattress pads, bath towels, hand towels and wash cloths per regulation.

On the allegation “Resident’s room is unsanitary”, the complainant had concerns about the cleanliness of R1’s room. Complainant commented that R1’s room was filthy, bed unmade, dirty sheets, trash can full, full dish of dried food, and the bathroom/toilet not cleaned in days. To investigate the allegation,
Continued on 9099-C.

SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene ChavezTELEPHONE: (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
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 29-AS-20200615164301
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: 09/08/2021
NARRATIVE
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LPA interviewed the former administrator on 6/24/20 at 11:12 am, W1 and W2 on 8/30/21 at 10:17 am and 1:38 pm and attempted to interview the complainant on 6/24/20 at 10:33 am and 8/30/21 at 1:31 pm. LPA toured R1’s room, obtained resident records, and reviewed a letter submitted by W1 dated 6/14/20.

On 6/24/20 at 11:35 am, LPA Chavez visited R1s room via televisit with Administrator Marsh and S2. LPA Chavez observed an empty trash can in bathroom, clean toilet and sinks (2), a clean refrigerator, floors clear of debris, and approximately ten toiletries on the hall counter top. R1 was in bed, wearing a nightgown, hair was clipped back with some falling on the face.

On 7/21/21, LPA reviewed the R1’s Admission Agreement and Housekeeping records. R1’s admission agreement shows on page 2, Section 1, A, 3 that the facility “will provide housekeeping services in your Residence weekly.” The housekeeping schedule shows that housekeeping service was to be performed every Thursday. For the time period of 4/21/20 through 6/26/20, R1 should have received nine weeks of service. However, housekeeping records indicate R1 received service on only two occasions, 4/30/20 and 5/07/20.

During a visit on 6/13/20, W1 states that R1’s room had “dirty dishes and things that should have been picked up.” W1 further commented on the state of R1’s room in a letter written 6/14/20, explaining that R1’s room had “clothes, pillows, and stuff were piled on every surface. R1’s bed was un-made and linens were filthy. Dust covered the surfaces. Old food and dirty dishes were on the counter. The floor was filthy and disgusting, the trash was overflowing.” Further, W1 reports that R1 had lost control of bowels, and “the splash was still on the dresser and cupboard.”

On 8/30/21 at 1:38 pm, LPA spoke with W2 who stated that they visited R1 on 6/13/20 at 1:00 pm. W2 states that the room was “a mess, there were stains on the carpet, and used drinking glasses and dishes with food in the room.” Based on the information obtained, the allegation that, ““Resident’s room is unsanitary”, is Substantiated. The facility did not ensure a clean, sanitary environment at all times for residents in care.

Exit interview conducted, deficiencies cited, and report and appeal rights emailed to Cathyann Paape.

SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene ChavezTELEPHONE: (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
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 29-AS-20200615164301
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: 09/08/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/10/2021
Section Cited
CCR
87307(a)(3)(C)
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87307 Personal Accommodations and Services: (a)(3)(c) Clean linen, including blankets, bedspreads, top bed sheets, bottom bed sheets, pillow cases, mattress pads, bath towels, hand towels and wash cloths...

The requirement was not met as evidenced by:
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Administrator will write a declaration stating that the facility will provide personal accommodations and services to residents in care in accordance with the regulation cited. Administrator shall submit a plan on how they will ensure residents are provided with clean linen in a quantity that shall be sufficient to permit changing at least weekly and more often, if necessary. Documentation will be provided to CCLD by 9/10/2021.
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Based on record review and interviews, the administrator did not provide clean linen in R1’s room. This poses a potential health and safety risk to resident in care.
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Type B
09/10/2021
Section Cited
CCR
87303(a)
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87303 Maintenance and Operation (a) ) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.

The requirement was not met as evidenced by:
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Administrator will write a declaration stating that the facility will maintain and operate in accordance with the regulation cited. Administrator shall submit a plan on how they will ensure residents are provided with clean and sanitary accommodations and in good repair at all times. Documentation will be provided to CCLD by 9/10/2021.
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Based on record review and interviews, the administrator did not provide a clean, sanitary residence. This poses a potential 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: 09/08/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 6
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
06/15/2020 and conducted by Evaluator Darlene Chavez
COMPLAINT CONTROL NUMBER: 29-AS-20200615164301

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: 50DATE:
09/08/2021
UNANNOUNCEDTIME BEGAN:
03:29 PM
MET WITH:Cathyann Paape, Business Office ManagerTIME COMPLETED:
04:24 PM
ALLEGATION(S):
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Staff increased resident’s rate
INVESTIGATION FINDINGS:
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On the allegation “Staff increased resident’s rate”, the complainant’s concern was that the facility increased R1's rent by $1,500 per month. To investigate the allegation, LPA interviewed the former administrator on 6/24/20 at 11:12 am, W1 on 8/30/21 at 10:17 am, and attempted to interview the complainant on 6/24/20 at 10:33 am and 8/30/21 at 1:31 pm. LPA also obtained financial and contractual records, and reviewed a letter submitted by W1 dated 6/14/20.

On 6/24/20 at 11:12 am, LPA interviewed the former administrator. Administrator stated that R1 was part of a rent control program under the City of San Luis Obispo Affordable Housing. In the program and documented in R1’s admission agreement, Appendix A signed 3/06/19, R1’s rent could not increase more than three percent (3%) annually. Monthly statements and ledgers from 2019 and 2020 indicate that R1 incurred a $100 per month rent increase on 1/01/20 and there is no record of a $1,500 rent increase.

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: 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.
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 29-AS-20200615164301
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: 09/08/2021
NARRATIVE
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On 8/30/21 at 10:17 am, LPA spoke with W1 who clarified the information provided in a letter dated 6/14/20. The letter states R1 “was going to need a higher level of care and they (facility) were going to raise rent an additional $1,500 dollars a month” to $3,450 per month. LPA confirmed with W1 that R1 would incur the extra $1,500 per month, if R1 stayed at the facility and additional services were provided. W1 stated that instead of incurring these costs, R1 was moved to a skilled nursing facility on 6/29/20.

Based on the information obtained, the allegation that, “Staff increased resident’s rate”, is Unsubstantiated. The facility is in compliance with the admission agreement and did not increase R1’s rent by more than 3% annually.

Exit interview conducted and report emailed to Cathyann Paape.

SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene ChavezTELEPHONE: (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
LIC9099 (FAS) - (06/04)
Page: 6 of 6