405850034-10-6-2023-29-AS-KBUY-CX5VF5-20231031162323

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405850034
Report Date: 10/06/2023
Date Signed: 10/06/2023 01:45:54 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
10/05/2023 and conducted by Evaluator Darlene Chavez

COMPLAINT CONTROL NUMBER: 29-AS-20231005161636

FACILITY NAME:	AVILA SENIOR LIVING AT DOWNTOWN SLO		FACILITY NUMBER:	405850034
ADMINISTRATOR:	DARLENE MARKHAM		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:	11:25 AM
MET WITH:	Darlene Markham, Administrator/Executive Director		TIME COMPLETED:	01:55 PM

ALLEGATION(S):

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Facility is unsanitary
Staff are not following proper food handling and storage

INVESTIGATION FINDINGS:

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On 10/6/23 at 11:25 am, Licensing Program Analyst (LPA) Chavez conducted an unannounced 10-day complaint investigation visit. LPA met with Darlene Markham, Administrator/Executive Director, and explained the reason for the visit.

On the allegation, “Facility is unsanitary,” the complainant’s concern was that the kitchen appeared dirty and unsanitary with soiled counters and floors. To investigate, LPA made observations and interviewed the administrator and food services director. LPA toured the kitchen with the administrator and observed the floor containing several food particles scattered throughout the kitchen and primarily in the food preparation areas and exit from the kitchen to the dining room. LPA observed stains on the kitchen floor which appeared to be food spills older than a day. LPA witnessed dirty dishes in the sink with a few flies landing on them and an opened screen door at the back of the kitchen. The administrator says she is unaware of the cleaning schedule and leaves that up to the food services director to take care of.
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: 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-20231005161636

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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At 12:20 pm, LPA interviewed Jose Diaz, Food Services Director. Director states that he cleans the kitchen floor daily at the end of the day and when he is not working, the cook cleans the floors. He says he does a deep cleaning once per week. He says sometimes he gets busy and does a quick cleaning, usually after breakfast because he says he is the only one working the kitchen and there is only one server.

Based on the evidence obtained, the allegation is deemed substantiated at this time.

On the allegation, “Staff are not following proper food handling and storage,” the complainant was concerned that there were several food items in the kitchen and storage areas that were opened, undated, and rotten. To investigate, LPA made observations.

LPA toured the kitchen with the administrator. In the refrigerators, LPA observed an open package of bagels, and unlabeled/undated bag of six loaves of bread, zip bag of hashbrowns, zip bag of sausage, sealed bag of possible pea soup, and two storage containers with chopped bell peppers and spinach without lids and labels, and a labeled bag of iceberg lettuce that was rancid. LPA observed a box of approximately 15 bruised, inedible pears and a potato on the floor. In the food storage room, LPA observed approximately 15 loaves of bread with no labels nor expiration dates and a container of approximately 20-50 pounds of sugar with the lid open, exposing the sugar.

Based on evidence obtained, the allegation is deemed substantiated at this time.

Exit interview conducted, deficiencies cited, and the report and appeal rights 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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Control Number 29-AS-20231005161636

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: 10/06/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/13/2023 Section Cited CCR 87555(b)(27)	1 2 3 4 5 6 7	87555(b)(27) Food Services (27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee has agreed to assign the maintenance department to conduct a deep cleaning of kitchen floors at minimum twice per week.
	8 9 10 11 12 13 14	Based on observation and interviews, the licensee did not comply with the section cited above in that the kitchen floor contained several food particles and stains appearing to be more than a day old which poses a potential health and safety risk to persons in care.	8 9 10 11 12 13 14
Type B 10/13/2023 Section Cited CCR 87555(b)(9)	1 2 3 4 5 6 7	87555(b)(9) Food Services (9) Procedures which protect the safety, acceptability and nutritive values of food shall be observed in food storage, preparation and service. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee has agreed to conduct a food storage and prepartion training with the kitchen staff and will send LPA a copy of the training sign-in sheet by the due dates.
	8 9 10 11 12 13 14	Based on observation, the licensee did not comply with the section cited above in that several food items in the refrigerator and food storage area are not stored properly which poses a potential health and safety risk to persons in care.l	8 9 10 11 12 13 14

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: 10/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023

LIC9099 (FAS) - (06/04)

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