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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 405850034
Report Date: 09/07/2022
Date Signed: 09/07/2022 04:43:23 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 SLOFACILITY NUMBER:
405850034
ADMINISTRATOR:KARI BOWRONFACILITY TYPE:
740
ADDRESS:475 MARSH STTELEPHONE:
(805) 541-4222
CITY:SAN LUIS OBISPOSTATE: CAZIP CODE:
93401
CAPACITY:100CENSUS: 57DATE:
09/07/2022
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Karen Enciso, Interim Executive Director/AdministratorTIME COMPLETED:
04:55 PM
ALLEGATION(S):
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Staff are using improper food handling and storage techniques
INVESTIGATION FINDINGS:
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On 9/07/22 at 2:30 pm, Licensing Program Analyst (LPA) Darlene Chavez conducted an unannounced 10-day complaint investigation visit to the facility above. LPA met with Karen Enciso, Interim Executive Director/Administrator, and explained the purpose of the visit.

On the allegation “Staff are using improper food handling and storage techniques,” the complainant’s concern was that there were “uncovered trays of shrimp cocktail in the fridge and a bowl or colander of shrimp sitting in the dish sink.” To investigate the allegation, LPA toured the kitchen, took photos, and interviewed staff.

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: 09/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2022
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-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: 09/07/2022
NARRATIVE
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On 9/7/22 at 2:55 pm, LPA toured the kitchen with the administrator. At 3:01 pm, LPA observed a bucket of approximately three dozen eggs that were uncovered/unlabeled in the refrigerator. At 3:03 pm, LPA encountered a malodor in the second refrigerator in the kitchen. It was determined that a food storage container of coleslaw covered with sheer plastic wrap and dated “9/4” had gone bad. At 3:07 pm, LPA witnessed a food storage container of salsa covered with a lid and a dish of pastry covered with clear plastic wrap were unlabeled.

On 9/7/22 at 3:09 pm, LPA interviewed Staff #1 (S1) who was working in the kitchen. S1 explained that dishes are never to be placed in the sink with food in them. S1 says staff are supposed to remove all food from the dishes and place it in the trash. LPA observed a trash can next to the sink with food which appeared to be food scraps. S1 says staff are then supposed to place the dishes on the counter next to the sink, not in the sink. S1 says they have seen dishes in the sink in the morning after the staff from the night before didn’t have time to do the dishes.

Based on evidence obtained, the allegation “Staff are using improper food handling and storage techniques,” is deemed Substantiated at this time. LPA observed food unlabeled and not stored properly.

Exit interview conducted, deficiency cited, and the report and Appeal Rights emailed to administrator.

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

DATE: 09/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 6
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: 09/07/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/08/2022
Section Cited
CCR
87555(b)(9)
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87555-General Food Service Requirements, (b...(9) Procedures which protect the safety, acceptability and nutritive values of food shall be observed in food storage, preparation and service.
The facility did not meet the requirements as evidenced by:
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Administrator immediately removed rancid food and will ensure that food items observed as improperly stored are stored in accordance with CCLD regulations immediately. Administrator will train kitchen staff on the regulation cited. Administrator will send to LPA by 9/8/22 a commitment to train kitchen staff by 9/12/22 or sooner. Administrator has committed to ensuring that all dining services and kitchen staff have their food handlers’ certificate. Administrator commits to ensuring any staff who do not have their certificate will do so by 9/12/22.
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Based on observations and interviews, the licensee did not comply with the above regulation. Food items were not stored properly and discarded prior to going rancid which poses 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: 09/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2022
LIC9099 (FAS) - (06/04)
Page: 3 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
08/30/2022 and conducted by Evaluator Darlene Chavez
COMPLAINT CONTROL NUMBER: 29-AS-20220830104941

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: 57DATE:
09/07/2022
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Karen Enciso, Interim Executive Director/AdministratorTIME COMPLETED:
04:55 PM
ALLEGATION(S):
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Facility does not have a current administrator on site
INVESTIGATION FINDINGS:
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On 9/07/22 at 2:30 pm, Licensing Program Analyst (LPA) Darlene Chavez conducted an unannounced 10-day complaint investigation visit to the facility above. LPA met with Karen Enciso, Interim Executive Director/Administrator, and explained the purpose of the visit.

On the allegation “Facility does not have a current administrator on site,” the complainant’s concern was that there was “No administrator on site sufficient to provide management and administration of the facility.” To investigate the allegation, LPA interviewed a credible witness, made observations, and reviewed records.

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: 09/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
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: 09/07/2022
NARRATIVE
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On 8/30/22 at 3:56 pm, LPA spoke with a credible Witness #1 (W1). W1 states that on 8/26/22, the administrator was not on-site and was not returning to the facility. W1 expressed that they were told the Activity Director and Resident Services Director were in charge and that “residents stated they did not know who to contact with questions or concerns.”

On 8/23/22, LPA visited the facility on a separate complaint. Interim administrator Amanda North informed LPA that she would be the acting administrator until Karen Enciso arrived on 8/29/22. On 8/30/22, LPA had a virtual meeting which Ms. Enciso attended and could be seen in the Executive Director’s office at the facility. On 8/30/22, Ms. Enciso provided sufficient documentation to LPA to change her to the facility’s administrator effective immediately. Regulation 87405 – Administrator Qualifications and Duties - states that “When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section.” Based on interviews, there were two Directors on-site on 8/26/22 acting as designated back-ups, and one of the Directors had previously occupied the facility’s Executive Director role.

Based on the evidence obtained, the allegation “Facility does not have a current administrator on site,” is deemed Unsubstantiated at this time. The facility had designated substitutes during the time an administrator was absent.

Exit interview conducted and the report emailed to the administrator.

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

DATE: 09/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 6