405850034-10-6-2023-29-AS-KBUY-CX5KU2-20231031081201

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405850034
Report Date: 10/06/2023
Date Signed: 10/06/2023 02:06:39 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
10/12/2022 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:	01:55 PM
MET WITH:	Darlene Markham, Administrator/Executive Director		TIME COMPLETED:	02:10 PM

ALLEGATION(S):

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Staff do not ensure a resident is fed timely

INVESTIGATION FINDINGS:

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On 10/6/23 at 1:55 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 ensure a resident is fed timely,” the complainant’s concern was that Resident #1 (R1) has Type 1 diabetes and needs to eat timely to regulate blood sugar. R1 has written doctor’s orders specifying this, but due to staff turnover, newer staff do not understand R1’s needs. LPA interviewed R1. R1 stated they are usually one of the first people in the dining room at meals to try to be served first to ensure blood sugar regulation. R1 stated the facility Administrator told them they could no longer keep orange juice in their room.
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-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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LPA reviewed doctor’s orders from May 2022 that ask for R1 to be served breakfast at 7:30am to assist with blood sugar regulation. The note also indicates R1 needs lunch by 11:30am and dinner by 4:30pm. In October 2022, R1 stated they arrived first in the dining room at 7:00am and waited 1.5 hours to receive food and did not get out of the dining room until 9:00am due to there only being 1 server. The facility did not follow doctor’s orders to ensure R1 was fed timely. R1 stated lunch and dinner have 2 servers so the wait was less.

LPA reviewed a similar set of doctor’s orders from January 2023 asking that R1 be served first in order to assist with blood sugar regulation. In January 2023, R1 stated the wait time for their meals had improved and they are usually served first due to their needs. LPA interviewed Administrator Erika Hampe on 10/14/22. Administrator stated she knew R1 needed to be served first due to their needs. However, Administrator was aware that the newer servers may not have known that R1 needed to be served first. Administrator stated they gave R1 a colored wristband to wear so that the servers would know R1 needs to be served first.

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

Exit interview conducted, deficiency cited, and 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-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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/06/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 10/09/2023 Section Cited CCR 87555(b)(7)	1 2 3 4 5 6 7	87555(b)(7) Food Services (7) Modified diets prescribed by a resident's physician as a medical necessity shall be provided. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Administrator states that current staff are well aware of R1’s dietary needs and are providing R1 with breakfast upon arrival to the dining room. Licensee has agreed to train new kitchen staff and wellness staff on residents’ modified dietary needs and administrator will send to LPA a Statement of Understanding of the regulation cited above.
	8 9 10 11 12 13 14	Based on record review and interviews, the licensee did not comply with the section cited above in that staff did not follow R1’s physician orders for a modified diet which poses an immediate health, safety, or personal rights risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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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