405850034-6-21-2023-29-AS-DCHZ-CSZW3M-20230621165611

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 405850034
Report Date: 06/21/2023
Date Signed: 06/21/2023 04:57:20 PM

Document Has Been Signed on 06/21/2023 04:57 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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
ADMINISTRATOR:	KAREN ENCISO		FACILITY TYPE:	740
ADDRESS:	475 MARSH ST		TELEPHONE:	(805) 541-4222
CITY:	SAN LUIS OBISPO	STATE: CA	ZIP CODE:	93401
CAPACITY:	100	CENSUS:	DATE:	06/21/2023
TYPE OF VISIT:	Case Management - Legal/Non-compliance	UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Marlene Nelson, Director of Regulatory Compliance		TIME COMPLETED:	05:10 PM

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On 6/21/23 at 10:10 am, Licensing Program Analyst (LPA) Chavez conducted an unannounced Case Management- Legal/Non-Compliance visit to monitor the licensee’s completion of the agreed-upon action items set forth in the Non-compliance Plan dated 3/30/23. LPA met with Marlene Nelson, Director of Regulatory Compliance (Director), and explained the reason for the meeting.

LPA focused today’s visit on the staffing plan dated 4/1/23. LPA interviewed the Director, residents, and staff, and reviewed documents. Interviews with staff reveal that “staffing has been better in the last couple of months,” staff say they have sufficient coverage and on days when staff call out, current staff are able to cover their shifts. Staff say that there has been a bit of turnover in the past month and that it can get tough sometimes, but overall it’s manageable. Staff say that staffing agencies are used only for future absences, i.e. vacations and leaves of absence. Residents interviewed say they are satisfied with staff responsiveness and staff are friendly.

LPA reviewed Shower Schedules and End of Shift Reports and found inconsistencies in how staff are documenting completed versus non-completed tasks. Director states that staff are trained to document exceptions on the End of Shift Reports, if they are unable to complete tasks and when there are changes to resident conditions. LPA observed End of Shift Reports indicating tasks completed and tasks not completed, some with reasons, others without reasons. Due to the lack of consistency, licensee will complete additional training with Wellness staff on documentation and processes. Licensee will send LPA a copy of the training sign-in sheets by 6/28/23.

Continued on 809-C.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene Chavez	TELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 06/21/2023

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At 2:20 pm, LPA toured the facility with the Director. LPA observed a Manager on Duty posting at the front desk with “Marlene Nelson” listed. Director provided a copy of a Manager on Duty calendar, however, it was not labeled and the last names and phone numbers were not listed. The schedule was not posted in each department as committed to on the Staffing Plan. Licensee will update the calendar to include full names of managers – primary and back-up, their schedules if more than one per shift, and their phone numbers, and will post in each department – Wellness, Maintenance, Food Services, Activities and Reception, and send LPA photos of calendar postings by 6/22/23.

LPA reviewed the staffing agency contracts. The contracts have been signed and dated by past and current Executive Directors.

Licensee will complete items listed above by the due dates. CCL will return in the future to continue to monitor the licensee’s completion of Non-compliance Plan items. No deficiencies at this time.

Exit interview conducted, report given.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene Chavez	TELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2023

LIC809 (FAS) - (06/04)

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