405850034-10-6-2023-29-AS-KBUY-CX5KU3-20231031081201

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405850034
Report Date: 10/06/2023
Date Signed: 10/06/2023 02:17:32 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
10/12/2022 and conducted by Evaluator Darlene Chavez

COMPLAINT CONTROL NUMBER: 29-AS-20221012120224

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: 54	DATE:	10/06/2023
		UNANNOUNCED	TIME BEGAN:	02:10 PM
MET WITH:	Darlene Markham, Administrator/Executive Director		TIME COMPLETED:	02:20 PM

ALLEGATION(S):

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Staff do not provide appropriate nutritional contents for the residents
Staff do not meet a resident’s diabetic needs while in care

INVESTIGATION FINDINGS:

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On 10/6/23 at 2:10 pm, Licensing Program Analyst (LPA) Darlene Chavez conducted an unannounced follow-up visit to deliver final findings on the original complaint dated 10/14/22. To investigate, LPA interviewed the administrator, staff, residents, and witnesses on 10/14/22 between 11:20 am and 12:45 pm, on 11/16/22 at 3:42 pm, 1/3/23 at 2:25 pm, and 7/31/23 at 1:32 pm. LPA met today with Darlene Markham, Administrator/Executive Director, and explained the purpose of the visit.

On the allegation, “Staff do not provide appropriate nutritional contents for the residents,” the complainant’s concern was that Resident #1 (R1) has Type 1 diabetes and needs to follow a low carb diet as prescribed by a physician. LPA observed and reviewed a list of residents with special diets in the kitchen and observed R1 on this list. Although the list indicated R1 needed a low carb diet, it did not indicate they needed to be served first. During the interview, R1 indicated they have been served an appropriate amount of proteins and carbs. However, they also mentioned that they would like to see lower carb options available, yet they also indicated they would like more rice with their meal. Based on the information obtained, the allegation is deemed unsubstantiated at this time. 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: 10/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023

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-20221012120224

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: 10/06/2023

NARRATIVE

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On the allegation, “Staff do not meet a resident’s diabetic needs while in care,” the complainant’s concern was that staff are not meeting R1’s diabetic needs. According to the reporting party, due to staff neglect, R1 has had blood sugar highs and lows that took a day or more to level out and could be avoided with assistance. R1 may need to drink fruit juice immediately if their blood sugar drops too low. According to the reporting party, R1 fainted once when food and insulin delivery were very late during the COVID lockdown, despite R1 calling the Wellness Department and asking them to bring insulin immediately. As a result, R1 fainted and ended up in the emergency room with bruised ribs.

Narrative charting and the hospital summary on 1/29/2022 indicate R1 had a fall, sat up on their chair and complained of pain and was sent out to the hospital for evaluation. The time R1 fell is unknown as is the cause of the fall, but R1 arrived at the hospital at 2:02pm. R1 returned to the facility at 5:45pm with diagnosis of syncope. The hospital summary indicates R1’s diagnoses as syncope and chest wall contusion. R1’s physician orders indicate R1 has a sliding scale for insulin injection 4 times a day (breakfast, lunch, dinner and bedtime) depending on the blood glucose level. R1’s MAR shows the glucose level is measured at 9am, 1pm, 5pm and 9pm and is documented, and shows if the insulin was given but does not show the exact time. There was no corroborating evidence to prove that R1’s fall and fainting were due to the low glucose levels. Based on the information obtained, the allegation is deemed unsubstantiated 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: 10/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023

LIC9099 (FAS) - (06/04)

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