405850034-3-17-2023-29-AS-KBUY-CR7LHZ-20230424084709

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405850034
Report Date: 03/17/2023
Date Signed: 03/17/2023 02:40:42 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
01/03/2023 and conducted by Evaluator Darlene Chavez

COMPLAINT CONTROL NUMBER: 29-AS-20230103092831

FACILITY NAME:	AVILA SENIOR LIVING AT DOWNTOWN SLO		FACILITY NUMBER:	405850034
ADMINISTRATOR:	ERIKA HAMPE		FACILITY TYPE:	740
ADDRESS:	475 MARSH ST		TELEPHONE:	(805) 541-4222
CITY:	SAN LUIS OBISPO	STATE: CA	ZIP CODE:	93401
CAPACITY:	100	CENSUS: 53	DATE:	03/17/2023
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Karen Enciso, Interim Executive Director, and John Kuester, Maintenance Director		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Residents not being provided their medications as prescribed.

INVESTIGATION FINDINGS:

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On 3/17/23 at 10:50 am, Licensing Program Analyst (LPA) Darlene Chavez conducted an unannounced follow-up visit to deliver final findings on the original complaint dated 1/3/23. LPA met with John Kuester, Maintenance Director, in the absence of the Interim Executive Director/Administrator, and explained the purpose of the visit.

On the allegation, “Residents not being provided their medications as prescribed,” the complainant’s concern was during the holidays, the residents did not get their medications or didn’t receive them in a timely manner due to staffing issues.

LPA interviewed R1 on 1/3/23 about the medication issues experienced on 1/1/23. R1 stated on 1/1/23, they asked for a pain pill at 5:30AM, and staff told R1 they were out of the pain pill, due to staff not asking for a refill on the medication. R1 also stated on 1/1/23, they received their regular AM medications late. R1 stated the AM medications are typically provided between 8am and 10am, but on 1/1/23 they were not provided until after 12 noon. 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: 03/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2023

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 3

Control Number 29-AS-20230103092831

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: 03/17/2023

NARRATIVE

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LPA reviewed R1’s MARs for January 2023, which indicates on 1/1/23 R1 received an oxycodone PRN for pain at 1:01pm and 5:26pm. The MARS indicate the medication was refilled on 12/22/22, to be taken as needed every 6 hours. Med Tech interview revealed the lead med tech contacted R1’s physician on 12/14/22 to refill the medication, and it was received on 12/22/22.

LPA interviewed med techs about the 1/1/23 early morning medications, and reviewed the Controlled Drug Record (CDR) with the med tech. Med tech stated the Controlled Drug Record (CDR) shows the Oxycodone PRN was given on 1/1/23 at 11:30am, another time that was not recorded but indicates a pill was given, 6pm, and at 11:30pm. Med tech stated although the MAR show a pill was given at 5:26pm, they typically round up the time on the CDR, which is why it shows 6pm instead.

The MAR shows the PRN medication was given twice on 1/1/23 but the CDR shows it was given 4 times. Med techs interviewed could not explain why there was a discrepancy. The facility had an adequate supply of the Oxycodone PRN for R1 because the medication was refilled on 12/22/22 and PRN pills were provided on 1/1/23. According to R1 they requested the pill at 5:30am but the first pill was not provided until at least 11:30am per the CDR and 1:01pm per the MAR.

LPA interviewed lead med tech, who stated two staff called out sick on 1/1/23, and they were the only one passing out medication and providing caregiving on the AM shift. According to the med tech, the last person to receive their AM medications was around 11am. Med tech also stated noon meds are typically handed out between 12pm and 1pm, and they were handed out by 2pm. The time regularly scheduled (non-PRN) meds are given is not recorded on the MAR.

When reviewing R1’s MAR, LPA noted the following medications do not indicate they were provided on 12/18/22, 12/25/22, or 12/26/22 and provide no reason as to why they were not given: 11pm Gabapentin 600 mg tablet; 11pm Meclizine 25 mg tablet; 11pm Melatonin 10 mg cap, 11pm Pantoprazole SOD DR 40mg tab; 11pm Trazodone 100 mg tablet; and 11pm Xtampza ER 18mg capsule. LPA also observed R1’s 1pm Meclizine 25 mg tablet does not indicate it was provided on 12/26/22, R1’s 5pm Xtampza ER 18 mg capsule was not provided on 12/31/22, and there are no notes that provide a reason as to why they were not given.

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 maintenance director.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene Chavez	TELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:	DATE: 03/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2023

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20230103092831

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: 03/17/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 03/18/2023 Section Cited CCR 87465(a)(4)	1 2 3 4 5 6 7	87465(a)(4) Incidental Medical and Dental Care. A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Administrator conducted training with all staff who are assisting residents with medications to ensure that residents get medications refilled and received on-time. Administrator sent CCL a Statement of Understanding of the regulation cited and proof the training was conducted on 3/6/23. POC cleared during visit.
	8 9 10 11 12 13 14	Based on record review, the licensee did not comply with the section cited above when medications were not given as prescribed, which poses an immediate health and safety 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: 03/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2023

LIC9099 (FAS) - (06/04)

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