405850034-7-13-2023-29-AS-KBUY-CU6PD7-20230728111303

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405850034
Report Date: 07/13/2023
Date Signed: 07/13/2023 01:25:07 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
07/10/2023 and conducted by Evaluator Darlene Chavez

COMPLAINT CONTROL NUMBER: 29-AS-20230710140924

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: 47	DATE:	07/13/2023
		UNANNOUNCED	TIME BEGAN:	11:13 AM
MET WITH:	Jutta Fairchild, Resident Care Director/LVN		TIME COMPLETED:	01:35 PM

ALLEGATION(S):

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Facility is not equipped with supplies of nonperishable foods for a minimum of one week

INVESTIGATION FINDINGS:

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On 7/13/23 at 11:13 am, Licensing Program Analyst (LPA) Chavez conducted an unannounced 10-day complaint visit to the facility above. LPA met with Jutta Fairchild, Resident Care Director/LVN, and explained the reason for the visit.

To investigate the allegation, LPA toured the facility and interviewed the administrator and staff. The administrator and head cook say the facility has a supply of nonperishables in the kitchen as well as a back-up supply of nonperishable food in storage for emergencies.

Continued on 9099-C.

Unsubstantiated

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: 07/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023

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-20230710140924

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: 07/13/2023

NARRATIVE

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LPA toured the kitchen and observed approximately 30 six-pound cans of tomato sauce, olives, sweet potatoes, pudding, syrup, preserves, pie filling, and two-pound cans of oats. LPA toured the storage units (2) which contained emergency supplies including 100 six-pound cans of chili con carne, corned hash, potatoes, fruit cocktail, tapioca pudding, tomato juice, and nearly 200 gallons of bottled water.

Based on the evidence obtained, the allegation, “Facility is not equipped with supplies of nonperishable foods for a minimum of one week,” is deemed Unsubstantiated at this time. LPA is advising that additional emergency food supplies are purchased to accommodate special dietary needs for residents in care. LPA is advising that the licensee communicate to Directors the location of emergency supplies. During interviews, the Food Services Director, Maintenance Director, and Resident Services Director were unaware of the location of emergency back-up food.

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: 07/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023

LIC9099 (FAS) - (06/04)

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