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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 405850034
Report Date: 03/01/2023
Date Signed: 03/01/2023 02:09:12 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
08/22/2022 and conducted by Evaluator Darlene Chavez
COMPLAINT CONTROL NUMBER: 29-AS-20220822102843
FACILITY NAME:AVILA SENIOR LIVING AT DOWNTOWN SLOFACILITY NUMBER:
405850034
ADMINISTRATOR:KARI BOWRONFACILITY TYPE:
740
ADDRESS:475 MARSH STTELEPHONE:
(805) 541-4222
CITY:SAN LUIS OBISPOSTATE: CAZIP CODE:
93401
CAPACITY:100CENSUS: 51DATE:
03/01/2023
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Cindy Morris, Interim Executive DirectorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility has inadequate staffing
Facility is in disrepair

INVESTIGATION FINDINGS:
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On 3/1/23 at 10:45 am, Licensing Program Analyst (LPA) Darlene Chavez conducted an unannounced follow-up visit to deliver final findings on the original complaint dated 8/22/22. LPA met with Cindy Morris, Interim Executive Director, and explained the purpose of the visit.

On the allegation, “Facility has inadequate staffing,” the complainant’s concern was that the facility kitchen had no cooks on 8/15/22 and 8/16/22. Residents waited an hour and a half for lunch on 8/16/22 due to no servers as well.

LPA reviewed a letter sent to Pacifica headquarters from residents, who stated a facility cook walked off their shift while the kitchen director was on vacation, which left the facility without a cook for over a week. A person from corporate filled in one day and two cooks from a sister facility filled in each one day, but there were still no cooks for multiple days before the kitchen director returned.
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: 03/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023
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 4
Control Number 29-AS-20220822102843
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: 03/01/2023
NARRATIVE
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The Administrator at the time, Kari Bowron, also tried to fill in during this time, and had the maintenance director and activities director helping as well. Residents indicated they wait 30-45 minutes to place their orders, and another 30-45 minutes to get their meals, and the food arrives cold. The letter indicates the facility only has one housekeeper and the residents’ sheets do not get changed at least weekly.

LPA interviewed interim Administrator Karen Enciso on 9/7/22. Enciso stated 4 new servers were hired and would start soon, the earliest starting in the facility on 9/9/22. Enciso also stated that new staff need to be trained and this was not happening, and “they’re” throwing people into the job without training.

According to staff interviews, due to a lack of staffing and no cooks working, pizza was ordered and brought in to feed residents dinner on 10/28/22. Staff interviews revealed that other staff at the facility were asked to work in the kitchen several times, usually on Fridays for lunch and dinner. Staff interviews revealed there were no servers in the dining room on Fridays, Saturday, or Sundays. Staff also stated the facility did not have a driver to transport residents. Multiple staff interviewed indicated the facility was short staffed. On 1/27/23, residents interviewed indicated they had to wait a long time to receive their meals, including up to 45 minutes to 1 hour.

LPA interviewed Administrator Erika Hampe on 10/14/22. Hampe indicated she had been serving in the dining room every day as well as another caregiver who helps with dish washing. Hampe stated there are 3 caregivers and 1 med tech, but since one caregiver was pulled to the kitchen they are not helping with caregiving. On 10/14/22 LPA observed Residential Services Director Alex Arrellanos and Activities Director Emily Villegas assisting in the kitchen. Based on the information obtained, the allegation is deemed Substantiated at this time.

On the allegation, “Facility is in disrepair,” the complainant’s concern was that the residents’ washer and dryer on the third floor has been out of service for six weeks, the patio furniture is in disrepair and dirty, the pedestrian gate leading to level one rooms has a broken latch, and the ovens are not working. To investigate, LPA toured the facility, interviewed the Sr. Vice President of Operations and Community Improvement Specialist, and reviewed records.

Continued on 9099-C.

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

DATE: 03/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 29-AS-20220822102843
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: 03/01/2023
NARRATIVE
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On 8/23/22 at 11:45 am, LPA observed the patio furniture on the third floor. The patio chairs, cushions, and table had dirt, bird feces and spider webs on them, the potted trees appeared dead, and the ground was covered in dirt. LPA toured the third-floor laundry room which was locked and had an Out of Order sign on the door. Upon entry, the two washing machines had “broken” signs on them. LPA observed the pedestrian gate which does not have a latch to open and close the gate. LPA also observed that the front left pillar in the facility’s front parking lot had a large broken piece of approximately 4 feet by 2 feet. On 1/3/23 at 12:15 pm, LPA observed by touch the patio chair cushions on the first-level patio chairs were soaking wet.

During the investigation, it revealed that 2 of the 3 ovens were not working, but there was one working oven. In January 2023, the third and only oven also stopped working. As of the delivery of this report, one of the ovens has been replaced so that there is one functional oven.

During the facility tour, LPA interviewed Rob Henderson, Sr. Vice President of Operations, and Amanda North, Community Improvement Specialist. Mr. Henderson and Ms. North were unaware of the items observed needing repair. Mr. Henderson states that this is his first time in the facility, and Ms. North says she was not aware of the repairs needed as she had not observed them prior to the tour.

On 8/26/22, LPA reviewed Maintenance Requests and found that on 6/6/22 and 6/24/22, requests were submitted indicating the washing machine(s) on the third floor were not working.

Based on the evidence obtained, the allegation, “Facility is in disrepair,” is deemed Substantiated at this time. Observations, interviews and records review show that facility equipment was not repaired or replaced in a timely manner.

Exit interview conducted, deficiencies cited, and the report and appeal rights given to the Interim Executive Director.

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

DATE: 03/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 29-AS-20220822102843
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: 03/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/08/2023
Section Cited
CCR
87411(a)
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87411(a) Personnel Requirements. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. This requirement was not met as evidenced by:
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Administrator has hired additional staff. Licensee will a commitment letter stating that a weekly assessment of staffing needs, plan ahead for personnel shortages, and also supplement with agency personnel. The letter will be sent to CCL by 3/8/23.
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Based on interviews and record review, the licensee did not comply with the section cited above in that residents waited 45 minutes to 1 hour to receive meals on several occasions due to insufficient staffing in the kitchen and dining room which poses a potential health, safety or personal rights risk to persons in care.
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Type B
03/08/2023
Section Cited
CCR
87303(a)
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87303(a) Maintenance and Operation. (a) The facility shall be clean, safe, sanitary and in good repair at all times. This requirement was not met as evidenced by:
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Licensee has replaced or repaired the resident washing machines, the gate latch, and the pillar. Licensee will clean the patios and ensure cushions are dry, and then send photos and video to CCL by 3/8/23 showing these repairs have been completed.
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Based on observations, interviews, and record review, the licensee did not comply with the section cited above in that patio furniture was dirty and water-drenched, patio areas were dirty, resident washing machines were inoperable for more than two months, a gate latch was broken, and an external pillar was crushed which pose a potential health, safety or personal rights risk to persons 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: 03/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4