405850034-3-1-2023-29-AS-KBUY-CPX3AU-20230314180519

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405850034
Report Date: 03/01/2023
Date Signed: 03/01/2023 02:05:51 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
08/30/2022 and conducted by Evaluator Darlene Chavez

COMPLAINT CONTROL NUMBER: 29-AS-20220830104941

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: 51	DATE:	03/01/2023
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Cindy Morris, Interim Executive Director		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility has inadequate staffing

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 8/30/22. 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 residents were still experiencing long wait times in the dining room, up to an hour to be served after giving their order. The complainant indicated about 20 minutes would be a reasonable wait time.

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 Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene Chavez	TELEPHONE: (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)

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Control Number 29-AS-20220830104941

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.

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

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene Chavez	TELEPHONE: (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 3

Control Number 29-AS-20220830104941

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)	1 2 3 4 5 6 7	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 which poses a potential health and safety risk to residents in care.	1 2 3 4 5 6 7	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.
	8 9 10 11 12 13 14	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 an immediate health, safety or personal rights risk to persons 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: 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)

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