405850034-10-12-2023-29-AS-KBUY-CX5VB9-20231031161711

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405850034
Report Date: 10/12/2023
Date Signed: 10/12/2023 02:13:03 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
08/30/2023 and conducted by Evaluator Darlene Chavez

COMPLAINT CONTROL NUMBER: 29-AS-20230830131611

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:	10/12/2023
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Darlene Markham, Administrator/Executive Director		TIME COMPLETED:	02:25 PM

ALLEGATION(S):

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Facility is incorrectly charging an SSI resident for basic rate services.
Insufficient staffing to meet residents’ needs.

INVESTIGATION FINDINGS:

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On 10/12/23 at 1:45 pm, Licensing Program Analyst (LPA) Darlene Chavez conducted an unannounced follow-up visit to deliver final findings on the original complaint dated 8/30/2023. To investigate, LPA interviewed Karen Enciso, interim administrator, staff, and residents on 8/22/23 at 2:08 pm, 8/30/23 at 11:25 am, 9/6/23 at 8:50 am, and 10/12/23 at 11:38 am, and reviewed records. Today, LPA met with Darlene Markham, Administrator/Executive Director, and explained the purpose of the visit.

On the allegation, “Facility is incorrectly charging a SSI resident for basic rate services,” the complainant’s concern was Resident 1 (R1) was accepted into the facility at the SSI rate but the facility is trying to charge additional money for services.

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: 10/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023

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-20230830131611

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: 10/12/2023

NARRATIVE

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LPA spoke with the interim administrator who states that Resident #1 (R1) needed additional services beginning in July 2023 and that the facility increased R1’s care plan level and fees on 9/1/23. She says that R1 receives SSI but that the “corporation’s legal team says we are not an ALW and don’t have to adhere to SSI residents.”

LPA reviewed R1’s Admission Agreement, statement of account for 7/1/22 through 9/1/23 and Resident Assessments. In R1’s Admission Agreement, signed by R1 and former Executive Director, section “VI.A – Fees”, the monthly basic rate is stated. In the same section, under “F. Payment and Failure to Make Payments,” the Agreement states that the facility “does not accept SSI/SSP eligible residents,” however, there is a written note next to this section by the Regional Director, Cassandra Bradford, which says an exception is being made.

Interim Administrator informs LPA that R1 did not have an assessment for their care level upon move-in to the facility, however, account statements show that R1 was on a care level 2 from move-in through 7/1/23. Assessments performed on 7/18/23 and 8/1/23 show that R1 reassessed at a Level 4 and statements on 8/5/23 and 9/1/23 reflect an increase in care level charges. R1’s 8/5/23 and 9/1/23 statements show increases totaling $1292 per month. CCL Tittle 22 Regulation 87464(e) Basic Services states, “If the resident is an SSI/SSP recipient, then the basic services shall be provided and/or made available at the basic rate at no additional charge to the resident.” It also includes, “(1) This shall not preclude the acceptance by the facility of voluntary contributions from relatives or others on behalf of an SSI/SSP recipient." At the time of R1’s move-in, a charitable organization made a commitment to subsidize R1’s basic rate. The facility accepted R1 with their SSI status along with the charity’s contribution. No further fees can be charged based on this acceptance.

LPA spoke with R1 and reinforced that R1 does not have a contractual obligation to pay additional fees beyond the basic rate established in the Admission Agreement. LPA also informed R1 that a volunteer can contribute to R1’s additional charges, however, they cannot be compelled to provide additional monies.

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

Continued on 9099-C.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene Chavez	TELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20230830131611

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: 10/12/2023

NARRATIVE

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On the allegation, “Insufficient staffing to meet resident needs,” the complainant’s concern was that the facility only had one staff person on the night shift on multiple days. The facility had a Non-Compliance Conference on 3/30/2023 and one of the items discussed was staffing. The licensee agreed to have 2 staff overnight to ensure sufficient staffing and had a “manager on duty” that could be contacted as needed. LPA interviewed the complainant who indicated there was only one staff overnight on 8/15/23, 8/22/23 and 8/23/23. LPA interviewed staff who indicated there was only one staff on 9/4/23 and 9/5/23.

Residents inform LPA that on 8/31/23, 9/3/23 and 9/4/23, there was one staff on the NOC shift. Witnesses say that a NOC shift staff is often by themselves as other caregivers call out frequently.

LPA reviewed timesheets for 8/15/23 through 9/5/23. Records indicate there was only one caregiving staff working the NOC shift on 8/21/23, 8/23/23, 8/24/23, 8/30/23, 8/31/23, 9/1/23, and 9/4/23. LPA reviewed pendant call button records for 8/15/23 through 8/31/23 for the NOC shift. Records for the NOC shift reveal that staff responded within 10 minutes, however, on 8/21/23, staff took 22 minutes to respond to a resident.

Based on records reviewed and the licensee’s commitment to having 2 staff overnight, the licensee did not ensure sufficient staffing and therefore, the allegation is deemed substantiated at this time.

Exit interview conducted, deficiencies 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: 10/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20230830131611

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: 10/12/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Request Denied Type B 10/19/2023 Section Cited CCR 87464(e)	1 2 3 4 5 6 7	Basic Services (e) If the resident is an SSI/SSP recipient, then the basic services shall be provided...at the basic rate at no additional charge to the resident. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee agrees to officially rescind the additional charges billed above the basic rate. Licensee will inform R1 in writing of the charges being removed and credited to R1’s account and that no additional charges will be billed as long as R1 resides in the facility.
	8 9 10 11 12 13 14	Based on records review and interviews, the licensee did not comply with the regulation cited above in that the licensee charged an SSI recipient additional fees beyond the basic rate established prior to move-in which poses a potential health, safety, or personal rights risk to resident in care.	8 9 10 11 12 13 14	Licensee will send a copy of letter to R1 of charges removed/credited to CCL by 10/19/23. Licensee also agrees that they will not evict R1 for non-payment of additional charges beyond the basic rate.
Type B 10/19/2023 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	Personnel Requirements – General, (a) Facility personnel shall at all times be sufficient in numbers...to meet resident needs… This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee has agreed to have management cover staff shifts when they call out and document this is taking place. Licensee has agreed to write a Statement of Understanding and send to CCL by 10/19/23.
	8 9 10 11 12 13 14	Based on interviews and record review, the licensee did not comply with the regulation cited above in that staffing was not sufficient in numbers to provide needed services to residents in care which poses a potential health, safety or personal rights risk to residents in care.	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: Rachael De Leon	TELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023

LIC9099 (FAS) - (06/04)

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