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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 405850034
Report Date: 03/17/2023
Date Signed: 03/30/2023 02:55:46 PM

Unsubstantiated


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 SLOFACILITY NUMBER:
405850034
ADMINISTRATOR:ERIKA HAMPEFACILITY TYPE:
740
ADDRESS:475 MARSH STTELEPHONE:
(805) 541-4222
CITY:SAN LUIS OBISPOSTATE: CAZIP CODE:
93401
CAPACITY:100CENSUS: 53DATE:
03/17/2023
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Karen Enciso, Interim Executive Director, and John Kuester, Maintenance DirectorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
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5
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8
9
Facility staff mismanaging resident(s) medication
INVESTIGATION FINDINGS:
1
2
3
4
5
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9
10
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13
On 3/17/23 at 10:50 am, Licensing Program Analyst (LPA) Darlene Chavez conducted an unannounced follow-up visit to deliver final findings. 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, “Facility staff mismanaging resident(s) medication,” the complainant’s concern was medications were provided untimely due to medications dropping on the ground.
On 1/27/23, LPA interviewed Resident #1 (R1) about R1’s medications. R1 stated on 12/30/22 around 9am, they heard a crash outside their room and observed pills on the ground from the medication cart. R1 told the med tech they did not want the pills that fell on the ground, and they called the LVN who then brought new pills 1 to 1.5 hours later. R1 stated they typically get their morning medications between 8am and 10am, so if the cart tipped over around 9am and new pills were received 1 to 1.5 hours later, the medication was not given substantially late. Additionally, the physician’s orders for these medications only state to give in the morning and do not denote a specific time. LPA interviewed med tech about the incident. Med tech stated the pills did drop on the floor but new replacement pills were provided within 1 hour to 1.5 hours.
Based on the investigation, the incident appears to have been an accident, and staff tried to provide replacement medications within a reasonable amount of time, therefore the allegation is deemed Unsubstantiated at this time. Exit interview, report given.
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: 03/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023
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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