405850034-11-2-2023-29-AS-KBUY-CY32YG-20231129164843

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405850034
Report Date: 11/02/2023
Date Signed: 11/02/2023 04:22:42 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
10/30/2023 and conducted by Evaluator Rachael De Leon

COMPLAINT CONTROL NUMBER: 29-AS-20231030151443

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: 53	DATE:	11/02/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Darlene Markham & Lupe llerenas		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are not following procedures for proper food storage.
Staff are not maintaining facility in a clean and sanitary condition.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) De Leon conducted a 10-day complaint visit to the facility above. LPA met with Lupe IIerenas Business Services Manager and explained the purpose of the visit. Administrator Marlene Markham was contacted an arrived around 11:30 am to complete an LIC 308 for Business Manager to complete the visit with LPA.

LPA requested a tour of the whole facility. At 10:30 AM LPM Burley arrived and joined LPA and Business Manager on the tour of the facility.

On the allegation: Staff are not following procedures for proper food storage. LPA toured the kitchen at 10:20 am with Business Manager. LPA asked kitchen staff for a hairnet before inspecting the kitchen and staff replied they were all out of them, neither the cook or the kitchen staff present were wearing a hairnet, At 10:22 am LPA took photographs of a bowl full of fruit not covered or dated in the refrigerator, a bowl of cereal sitting out on a food shelf with no cover, the ice cream did not have any covers or lids in the freezer box,

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Rachael De Leon	TELEPHONE: (805) 450-0262
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 29-AS-20231030151443

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: 11/02/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

at 10:23 am an open bag of frozen food was not sealed or closed properly in the freezer, the lids on the ice cream were not secured, the stove area was dirty with left over food from breakfast, bread crumbs and a cup were left on the counter by the toaster, and the beverage dispenser needs to be cleaned. The kitchen floor and walls were in need of cleaning. The dining area was clean and sanitary. Based on the evidence this allegation is deemed Substantiated at this time.

On the allegation: Staff are not maintaining facility in a clean and sanitary condition. LPA took photographs on the tour of the facility. LPA observed and took photographs at 10:48 am-12:57 PM the front entry tile was dirty with debris and black marks on the tile, the carpet in the atrium had several spots that needed to be cleaned, the tile along the apartments had spills of what looked like coffee that had not been cleaned up, the walls and doors had dark scuffs marks and small spots of dry wall were damaged, the walls had dirty marks that need to be wiped off, in front of the media room the tile is dirty and in need of cleaning, the wood tables in the atrium did not appear to be clean and sanitary as what appeared to be cup marks were on the tables as well as smudges and fingerprints, the doorway to resident apartments needed vacuuming and one door plate had no screws to keep it in place, one of the exiting doors door trim was not installed properly leaving a gap and exposing nails, the carpet around the facility was in need of vacuuming, not all wastebaskets had tight fitting covers, carpet was frayed in one corner of the building, one wall had a patch that had not been painted, windows ledges were dusty, the facility had cobwebs throughout the lighting, railing and skylights of the facility, the carpet on the outside units had large water stains under the air-conditioning units and planters, one air conditioning unit had a broken vent, the blinds and window seals throughout the facility are dusty, several lights were in need of new bulb and the 2nd floor lighting was not working and no one could confirm if the lights worked, the gates around the outside back courtyard were in need of repair, a large broken piece of glass was laying out in the garden area, one of the cottages doors were blocked with chairs and planting soil bags, stairwell door is in need of repair, a ramp was lifted and in need of repair and one of the back fences is leaning and in need of repair. Based on the evidence this allegation is Substantiated at this time.

Exit interview conducted, deficiencies cited, civil penalties assessed, copy of report and appeal rights printed for Business Manager.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Rachael De Leon	TELEPHONE: (805) 450-0262
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 29-AS-20231030151443

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: 11/02/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/09/2023 Section Cited CCR 87555(b)(9)	1 2 3 4 5 6 7	(9) Procedures which protect the safety, acceptability and nutritive values of food shall be observed in food storage, preparation and service. This requirements was not met as evidenced by:	1 2 3 4 5 6 7	Administrator agreed to have the kitchen staff take trianing to get food handler certifcates and clean the entire kitchen including stove, freezers, refrigerator, walls and flooring and send pictures to CCL.
	8 9 10 11 12 13 14	Based on observation and photographs the licensee did not comply the facility staff are not following proper food storage requirements which posses a potential health and safety risks to reisdnets in care.	8 9 10 11 12 13 14
Type B 11/09/2023 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. this requirement was not met as evidenced by:	1 2 3 4 5 6 7	Administrator agreed to have the facility whole facility inside and outside cleaned, sanitized and repaired. Read and review regulation 87303 and send photographs to CCL.
	8 9 10 11 12 13 14	Based on observation and photographs the licensee did not comply as the facility windows, blinds, walls, doors, floors, carpets, tiles, and furnishings were not kept clean which poses a potential health and safety risk to residnets 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) 450-0262
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 3